急诊科重症患者医院感染的病原学特点及相关因素研究

Etiological characteristics and related factors for nosocomial infections in critically ill patients of emergency department

目的探究急诊科重症患者医院感染的病原学特点及相关因素。方法选择医院2016年4月-2017年4月收治的274例急诊科重症患者,观察其医院感染的病原学特点及相关因素。结果 274例急诊科重症患者发生医院感染111例,感染率为40.51%;且行血培养共发现病原菌188株,主要以金黄色葡萄球菌及铜绿假单胞菌为主,分别占17.02%、19.15%;金黄色葡萄球菌对万古霉素、左氧氟沙星敏感性较好,对头孢唑林、头孢噻肟耐药性较强;铜绿假单胞菌对替考拉宁、磺胺甲唑/甲氧苄啶、左氧氟沙星较为敏感,对头孢曲松、红霉素耐药性较强;气管切开、年龄、胃管置入、机械通气、深静脉置管、术后预防性使用抗菌药物、卧床时间、糖尿病均是导致急诊科重症患者医院感染的影响因素(P<0.05)。结论了解急诊科重症患者医院感染常见的病原菌,有助于指导疾病的治疗,熟悉掌握医院感染的相关因素,可及时做出针对、有效性预防。

OBJECTIVE To explore the etiological characteristics and related factors for nosocomial infections in critically ill patients of emergencey department.METHODS A total of 274 critically ill patients who were treated in emergency department from Apr 2016 to Apr 2017 were enrolled in the study,and the etiological characteristics and related factors for the nosocomial infections were observed.RESULTS Of the 274 critically ill patients of emergency department,111 had nosocomial infections,with the infection rate 40.51%.Totally 188 strains of pathogens were isolated from blood specimens,and Staphylococcus aureus and Pseudomonas aeruginosa were the predominant species of pathogens,accounting for 17.02%and 19.15%,respectively.The S.aureus strains were highly susceptible to vancomycin and levofloxacin but were highly resistant to cefazolin and cefotaxime;the P.aeruginosastrains were highly susceptible to teicoplanin,sulfamethoxazole-trimethoprim and levofloxacin but were highly resistant to ceftriaxone and erythromycin.The influencing factors for the nosocomial infection in the critically ill patients included tracheotomy,age,gastric intubation,mechanical ventilation,deep venous catheter indwelling,postoperative antibiotics phylaxis,bedridden time and diabetes mellitus（P0.05）.CONCLUSIONIt is necessary to understand the common species of pathogens causing the nosocomial infections in the critically ill patients of emergency department and make clear of the related factors for the nosocomial infection so as to provide guidance for treatment and take targeted,effective prevention measures.