妊娠期糖尿病患者医院感染病原学及影响因素分析

Etiological characteristics and influencing factors for nosocomial infection in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病患者医院感染病原学特点及影响因素。方法选择医院于2015年3月-2018年3月住院妊娠期糖尿病患者970例,分析医院感染发生情况。采集患者痰液、尿液及血液等标本,分离培养病原菌并进行药敏试验,统计分析相关影响因素。结果妊娠期糖尿病患者970例,医院感染48例(4.95%)其中以呼吸道(54.17%)和泌尿道(27.08%)感染为主;共分离出病原菌61株,其中革兰阴性菌36株(59.02%),主要为肺炎克雷伯菌(21.31%)、大肠埃希菌(16.39%);革兰阳性菌25株(40.98%),主要为金黄色葡萄球菌(18.03%)、表皮葡萄球菌(14.75%);肺炎克雷伯菌对哌拉西林耐药率为76.92%,大肠埃希菌对头孢呋辛耐药率为70.00%;金黄色葡萄球菌对青霉素G耐药率为72.72%,表皮葡萄球菌对环丙沙星耐药率为77.78%。经多因素Logistic回归分析,空腹血糖、住院时间、侵入性操作和应用抗菌药物为影响妊娠期糖尿病患者医院感染独立危险因素。结论妊娠期糖尿病患者医院感染分离病原菌主要为革兰阴性菌,医院感染受多因素影响,应采取针对性预防措施及合理应用抗菌药以物降低医院感染发生率。

OBJECTIVE To explore the etiological characteristics and influencing factors for nosocomial infection in the patients with gestational diabetes mellitus. METHODS A total of 970 patients with gestational diabetes mellitus who were hospitalized from Mar 2015 to Mar 2018 were enrolled in the study, the incidence of nosocomial infection was analyzed. The sputum, urine and blood specimens were collected from the patients, the drug susceptibility testing was performed for the isolated pathogens, and the related influencing factors were statistically analyzed. RESULTS Of 970 patients with gestational diabetes mellitus, 48(4.95%) had nosocomial infection, 54.17% of whom had respiratory tract infection, and 27.08% had urinary tract infection. Totally 61 strains of pathogens were isolated, 36(59.02%) of which were gram-negative bacteria, and 25(40.98%) were gram-positive bacteria. Klebsiella pneumonia and Escherichia coli were the predominant species of the gram-negative bacteria, accounting for 21.31% and 16.39%, respectively;Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram-positive bacteria, accounting for 18.03% and 14.75%, respectively. The drug resistance rate of the K.pneumoniae strains to piperacillin was 76.92%, and the drug resistance rate of the E.coli strains to cefuroxime was 70.00%;the drug resistance rate of the S.aureus strains to penicillin G was 72.72%, and the drug resistance rate of the S.epidermidis strains to ciprofloxacin was 77.78%. Multivariate logistic regression analysis showed that the fasting blood glucose, length of hospital stay, invasive operation and use of antibiotics were the independent risk factors for the nosocomial infection in the patients with gestational diabetes mellitus. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated form the gestational diabetes mellitus patients with nosocomial infection, there are a variety of influencing factors for the nosocomial infection. It is necessary to take targeted prevention measures and reasonably use antibiotics so as to reduce the incidence of nosocomial infection.