脑梗死合并医院感染的临床特点与危险因素分析

Clinical characteristics and risk factors of nosocomial infections in ischemic stroke patients

目的回顾性分析脑梗死合并医院感染患者临床特点及危险因素,明确医院感染发生的可能易感因素。方法根据纳入及排除标准,入组1054例脑梗死患者,根据是否合并医院感染分为2组,即非院感组(n=992)与院感组(n=62),分析院感组的感染部位、病原菌分布,比较两组的年龄、既往史、TOAST分型、入院时NIHSS评分、住院天数及费用等临床特征,分析脑梗死后发生医院感染的易感因素。结果脑梗死合并医院感染62例(5.88%),以下呼吸道感染为首(45.16%);共培养出60株病原菌,以革兰氏阴性菌为主(50%)。多因素logistic回归分析提示:心源性脑栓塞(OR=2.80)、住院超过11d(OR=4.50)、吞咽困难(OR=2.78)为脑梗死合并医院感染的独立危险因素。结论TOAST分型为心源性脑栓塞、住院时间长且合并吞咽困难的脑梗死患者是发生医院感染的易感人群,以下呼吸道感染多见,病原菌以革兰氏阴性菌为主,应有针对性地做好相应预防和干预措施。

Objective To investigate the possible susceptible factors of nosocomial infection in patients with ischemic stroke. Methods A total of 1054 cases of ischemic stroke were retrospectively enrolled in the study. The information of nosocomial infection was recorded. Clinical characteristics were compared between infection group (n=992) and non-infection group (n=62). The infection site and pathogen distribution were also analyzed. Logistic regression analysis was performed to analyze the risk factors of nosocomial infection in patients with ischemic stroke. Results Of the 1054 cases of ischemic stroke, 62 cases were complicated with nosocomial infection (5.88%). The most infection site was lower respiratory tract (45.16%). A total of 60 strains of pathogens were isolated, among which there were a total of 30 (50%) of gram-negative bacteria. The multi-factor logistic regression analysis suggested that cardiac cerebral embolism (OR=2.80), dysphagia (OR=2.78) and the hospital stay (≥11 days, OR=4.50) were independent risk factors for nosocomial infection in patients with ischemic and the pathogenic bacteria were mainly gram-negative bacteria. More attention should be paid to reduce the incidence of nosocomial infection.