缺血性脑卒中患者医院感染的特点

Nosocomial infection of patients with ischemic stroke

目的对经过不同诊疗路径的卒中中心急性缺血性脑卒中患者进行分析,研究病原菌检出和发生医院感染类型的情况,为制定更有效的医院感染防控方案提供依据。方法回顾性分析某大型三甲医院卒中中心2014年1月-2019年3月收治的急性缺血性脑卒中患者533例的临床资料,对感染率、感染例次率、感染类型及病原菌分布情况进行分析。结果收治的533例急性缺血性脑卒中患者发生医院感染55例次,例次感染率为10.32%。急性缺血性脑卒中患者经过卒中中心急诊静脉溶栓、血管内介入治疗和桥接治疗后,分流到病房发生的医院感染例次率分别为10.92%、8.11%、11.88%,差异无统计学意义(P=0.947)。排名前三位感染类型:下呼吸道感染40例占72.73%,泌尿道感染8例占14.55%,血流感染4例占7.27%;感染患者共培养分离病原菌78株,革兰阴性菌54株占69.23%,以铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌为主;15株革兰阳性菌占19.23%,以金黄色葡萄球菌为主;真菌9株占11.54%,以光滑假丝酵母和近平滑假丝酵母为主。结论急性缺血性脑卒中患者易发生肺部感染和泌尿道感染,感染病原体主要以革兰阴性菌为主,需做好感染防控和持续改进。

OBJECTIVE To investigate pathogen detection and type of hospital infection through anasis on the different diagnostic pathway of patients with acute ischemic stroke in stroke centers,and provide the basis for more effective prevention and control strategies of hospital infection management.METHODS Retrospective analysis were carried out on the clinical data of 533acute ischemic stroke patients in the stroke center of a large-scale top three hospital from January,2014to March,2019,and then the infection rate,infection case rate,type of infection and distribution of pathogens were analyzed systematically.RESULTS Among 533acute ischemic stroke patients,55cases occurred nosocomial infection,and the case rate of infection was 10.32%.The case rate of nosocomial infections of patients with emergency intravenous thromolysis,endovascular interventioanl treatment and bridging treatment in the ward was 10.92%,8.11%,11.88%,respectively(P=0.947).The 40cases of lower respiratory tract infection,8cases of urinary tract and 4cases bloodstream infections are the the top three infection types,accounting for 72.73%,14.55%,and 7.27%,respectively.78strains of pathogenic bacterial were isolated from infected patients,among which 54cases were Gram-negative bacteria,accounting for 69.23%,dominated by Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella pneumoniae;15strains were Gram-positive bacteria,accounting for 19.23%,dominated by Staphylococcus aureus;and 9strains were fungi,accounting for 11.54%,dominated by smooth Candida and C.sphaeroides mainly.CONCLUSIONPatients with acute ischemic stroke are susceptible to pulmonary and urinary tract infection,of which Gram-negative bacteria are the dominantpathogens of infection.Therefore,the prevention and control of infection,and continuous improvement of infection is urgent.