脊髓损伤患者医院感染的临床特点及危险因素分析

Clinical Characteristics and Risk Factors of Nosocomial Infection in Patients with Spinal Cord Injury

目的探讨脊髓损伤患者医院感染的发生部位、病原菌特点及危险因素。方法回顾性调查2015年1月至2017年6月期间526例脊髓损伤住院患者的临床资料,总结医院感染病原菌的分布情况及菌株耐药性特点;对医院感染的危险因素进行分析。结果共有159例次发生医院感染,感染的主要部位为泌尿道(60.4%)和下呼吸道(28.9%)。主要致病菌是大肠埃希菌(39.0%)、铜绿假单胞菌(15.7%)、肺炎克雷伯杆菌(11.3%)和奇异变形杆菌(9.4%);致病菌对二、三代头孢菌素和喹诺酮类抗生素中高度耐药,而对含β-内酰胺酶抑制剂的复方制剂、碳青霉烯类和氨基糖苷类抗生素较敏感;住院时间、脊髓损伤程度、侵入性操作、营养风险、抗菌药物联合使用是发生医院感染的相关危险因素(P<0.05)。结论脊髓损伤患者医院感染的部位多为泌尿道和呼吸道;致病菌以革兰阴性杆菌为主,常呈多重耐药;临床应针对医院感染的危险因素进行相应干预,以提高患者的生活质量。

Objective To explore the characteristics of nosocomial infection in patients with spinal cord injury,and analyze the risk factors. Methods From January,2015 to June,2017,526 patients with spinal cord injury in our hospital were reviewed.The distribution of pathogens and the characteristics of drug resistance of strains were summarized,and the risk factors of nosocomial infection were analyzed. Results There were 159 person-times with nosocomial infection,and most of the infections were found in urinary tract (60.4%) and lower in respiratory tract (28.9%).The main pathogenic germs were Escherichia coli (39.0%),Pseudomonas aeruginosa (15.7%),Klebsiella pneumoniae (11.3%) and Proteus mirabilis (9.4%).The main pathogens were resistant to second or third generation of cephalosporins and quinolones moderately or severely,but sensitive to compound preparations containing beta-lactamase inhibitors,carbapenems and aminoglycosides.The risk factors for the nosocomial infections in the spinal cord injury patients included the hospitalization time,severity of spinal cord injury,invasive operation history,nutritional risk and use of antibiotics (P < 0.05). Conclusion Most of the nosocomial infections in patients with spinal cord injury are in urinary tract and respiratory tract.Gram-negative bacilli are the main pathogenic bacteria,which often show multiple drug resistance.It is necessary to take targeted interventions according to the risk factors of nosocomial infections in order to improve the quality of life of patients.