肝硬化患者消化道出血医院感染的影响因素分析

Influencing factors for nosocomial infections in liver cirrhosis patients complicated with gastrointestinal bleeding

目的研究肝硬化消化道出血患者医院感染的影响因素及病原菌特点。方法选取医院2014年2月-2016年2月医院收治的肝硬化并发消化道出血患者225例,回顾性分析患者的临床资料,进行单因素和多因素非条件Logistic分析肝硬化并发消化道出血患者发生医院感染的影响因素。结果 225例患者中48例发生医院感染,感染率为21.33%,感染类型排在前三位的分别为呼吸道感染、细菌性腹膜炎以及肠道感染,分别占39.58%、20.83%及18.76%;单因素分析结果显示,肝硬化消化道出血患者医院感染与性别、预防性抗菌药物使用以及急性消化道出血差异无统计学意义;与年龄、住院时间、肝功能、白细胞计数、清蛋白水平以及侵入性操作关系密切(P<0.05);非条件Logistic多因素分析显示,年龄、住院时间、肝功能、白细胞、清蛋白以及侵入性操作是肝硬化消化道出血医院感染的相关因素(P<0.05);48例肝硬化消化道出血医院感染患者中共分离出19株病原菌,排在前2位的分别为大肠埃希菌、肺炎克雷伯菌,分别占47.37%和21.05%。结论肝硬化消化道出血医院感染影响因素相对较多,应根据影响因素采取积极有效的措施应对,以降低感染率。

OBJECTIVE To explore the influencing factors and etiological characteristics of nosocomial infections in liver cirrhosis patients complicated with gastrointestinal bleeding.METHODS A total of 225 liver cirrhosis patients complicated with gastrointestinal bleeding who were treated in the hospital from Feb 2014 to Feb 2016 were enrolled in the study,the clinical data of the patients were retrospectively analyzed,and the univariate analysis and non-conditional multivariate logistic analysis were performed for the influencing factors for the nosocomial infections in the liver cirrhosis patients complicated with gastrointestinal bleeding.RESULTS Of the 225 patients,48 had nosocomial infections,with the infection rate 21.33%,of whom 39.58% had respiratory tract infections,20.83% had bacterial peritonitis,and 18.76% had intestinal infections.The result of the univariate analysis showed that the incidence of nosocomial infections in the liver cirrhosis patients complicated with gastrointestinal bleeding was not associated with the gender,prophylactic use of antibiotics or acute gastrointestinal bleeding but was closely associated with the age,length of hospital stay,liver function,white blood cells counts,serum albumin level and invasive operations（P〈0.05）.The non-conditional multivariate logistic analysis indicated that the related factors for the nosocomial infections in the liver cirrhosis patients complicated with gastrointestinal bleeding included the age,length of hospital stay,liver function,white blood cells counts,serum albumin level and invasive operations（P〈0.05）.Totally 19 strains of pathogens were isolated from the 48 liver cirrhosis patients complicated with gastrointestinal bleeding;the Escherichia coli and Klebsiella pneumoniae ranked the top 2 species among the isolated pathogens,accounting for 47.37% and 21.05%,respectively.CONCLUSIONThere are a variety of influencing factors for the nosocomial infections in the liver cirrhosis patients complicated with gastrointestinal bleeding,and it is necessary to take targeted measures on the basis of the influencing factors so as to reduce the infection rate.