急诊重症患者医院感染病原菌分布及影响因素分析

Distribution of pathogens causing nosocomial infections in emergency critically ill patients and influencing factors

目的探讨急诊重症患者医院感染的影响因素及病原菌分布。方法选取医院于2012年1月-2016年12月收治的急诊重症患者2 700例,回顾性分析感染患者的临床资料,采用单因素及多因素Logistic回归对重症患者医院感染相关影响因素进行分析,采集感染患者临床标本进行细菌培养与鉴定。结果 2 700例急诊重症患者,发生医院感染287例,感染率10.63%,感染部位以下呼吸道感染为主;多因素Logistic回归结果显示年龄、住院时间、侵入性操作、使用抗菌药物为急诊重症患者医院感染独立影响因素;287例感染患者,共分离出病原菌400株,其中革兰阴性菌240株占60.00%,革兰阳性菌120株占30.00%,真菌40株占10.00%。结论急诊重症患者医院感染病原菌以革兰阴性菌为主,年龄、住院时间、侵入性操作、大量使用抗菌药物为急诊重症患者医院感染的独立影响因素;必须提高急诊科预防医院感染与合理用药理念,且减少侵入性操作,合理使用抗菌药物,从而降低急诊科医院感染率。

OBJECTIVE To explore the influencing factors for nosocomial infections in emergency critically ill pa- tients and observe the distribution of pathogens.METHODS A total of emergency critically ill patients who were treated in the hospital from Jan 2012 to Dec 2016 were enrolled in the study, the clinical data of the patients with infections were retrospectively analyzed, the univariate analysis and multivariate logistic regression analysis were performed for the related influencing factors for the nosocomial infections, the clinical specimens that were ob- tained from the patients with infection were cultured, and the isolated pathogens were identified.RESULTS Of the 2700 emergency critically ill patients, 287 had nosocomial infections, with the infection rate 10.63%.The lower re- spiratory tract was the major infection site.The result of the multivariate logistic regression analysis showed that the age, length of hospital stay, invasive operations and use of antibiotics were the independent influencing factors for the nosocomial infections in the emergency critically ill patients.Totally 400 strains of pathogens were isolated, of which 240 （60.00%） were gram-negative bacteria, 120 （30.00%） were gram-positive bacteria and 40 （10.00%） were fungi.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the nosocomial infections in the emergency critically ill patients.The age, length of hospital stay, invasive operations and excessive use of antibiotics are the independent influencing factors for the nosocomial infections in the emergency critically ill patients.It is necessary to boost the idea of prevention of nosocomial infections and reasonable use of antibiotics in emergency department, reduce the invasive operations and reasonably use antibiotics so as to reduce the incidence of nosocomial infections in the emergency department.