神经重症病房内发生院内感染的调查与分析

Investigation and Analysis of Nosocomial Infection in Neurological Intensive Care Unit

目的探讨神经重症病房内发生院内感染的危险因素及其对患者的影响,为制定合理、有效的院内感染预防方案提供依据。方法回顾性分析海门市人民医院2016年3月-2018年2月神经重症病房内连续收治的1 248例患者。其中74例(5.9%)发生院内感染;23例检出产超广谱β-内酰胺酶菌(extended-spectrumβ-lactamase,ESBL),18例检出耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)。结果74例院内感染患者中,57例在神经重症治疗期间发生院内感染;2例患者检出ESBL,2例患者检出MRSA。63.9%的患者预防性使用抗生素,9.7%患者使用抗生素治疗。多因素Logistic回归分析院内感染影响因素,建立人工气道(OR 2.65,95%CI 1.79~3.86,P=0.006),NICU内治疗时间(OR1.86,95%CI 1.17~2.96,P=0.008),手术切口并发症(OR1.25,95%CI 1.03~1.87,P=0.018),预防性使用抗生素(OR 0.52,95%CI 0.31~0.76,P=0.003)。院内感染患者具有较长NICU内住院时间(P<0.001),高死亡率(P=0.006)。结论发生院内感染的影响因素有建立人工气道、手术切口并发症、NICU内住院时间及预防性使用抗生素。本研究表明发生院内感染和不良预后、重症病房住院时间有密切关系。

Objective To expolore the risk factors for nosocomial infections(NI)in patients of neuro intensive care unit so as to provide objective basis for prevention and control of the nosocomial infections.Methods A single-centre prospective observational cohort study was conducted on 1 248 acut brain disease patients.There were 74(5.9%)patients with nosocomial infection;23 with extended spectrum beta-lactamase(esbl);18 with methicillin-resistant staphylococcus.Results From 74 NI patients,57 had onset of NI during their NICU stay;ESBL in 2 patients,MRSA in2 patients.Predictors of NI in prophylaxis was given to 63.9%patients,in therapy to 9.7%patients.Predictors of NI in multivariate logistic regression analysis were airways(OR 2.65,95%CI 1.79~3.86,P=0.006),NICU stay(OR 1.86,95%CI 1.17~2.96,P=0.008),wound complications(OR1.25,95%CI 1.03~1.87,P=0.018),antibiotic prophylaxis(OR 0.52,95%CI 0.31~0.76,P=0.003).NI patients had longer stay(P<0.001),higher mortality(P=0.006).Conclusion Strong predictors for onset of nosocomial infection were accesses such as airways,NICU stay,antibiotic prophylaxis and wound complications.This study confirmed nosocomial infection is associated with worse outcome and longer NICU stay.