热带地区某综合医院院内真菌感染情况调查

Investigation and analysis of nosocomial fungal infection in a general hospital in tropical areas

目的探讨住院患者医院内真菌感染的分布特点及危险因素,为制定有效的防控措施提供依据。方法采用回顾性分析方法,对解放军总医院海南医院2013年1月-2017年12月住院患者中医院内真菌感染病例406例进行回顾性分析。以同期住院患者医院内非真菌感染病例1 514例为对照组,对可能的影响因素用χ^2检验先进行单因素分析,将单因素分析有统计学意义(P<0.05)的变量引入非条件Logistic回归分析中行多因素分析。结果 >60岁年龄段发生真菌感染的比例最高,占66.50%。>70~80岁患者中死亡例数所占的比例最高,占26.67%。真菌感染患者中以假丝酵母菌属感染为主,占88.04%。真菌感染部位以肺部感染居首位,占47.6%。侵袭性念珠菌感染白色念珠菌感染所占的比例最高,占47.07%。危险因素分析:单因素χ^2检验显示,9个变量是影响真菌感染的危险因素(P<0.05),将9个变量纳入非条件Logistic回归分析中,按照OR值的大小,分别为抗菌药物使用种类、年龄、是否曾住ICU、侵入性操作、住院时间。结论加强老年患者保护性隔离措施,加强病房环境消毒隔离,对于高龄、接受侵入操作治疗患者应加强病原学监测,严格掌握抗菌药物的使用指征,有助于控制医院内真菌感染。

Objective To explore the distribution characteristics and risk factors of nosocomial fungal infections in hospitalized patients, so as to provide evidence for effective prevention and control measures. Methods A retrospective analysis was made on the nosocomial fungal infections of inpatients in Hainan Hospital of PLA General Hospital from 2013 to2017. 1 514 patients with non-fungal nosocomial infection in the same period were selected as the control group, and the possible influencing factors were analyzed by chi-square test first, the significant variables of univariate analysis(P<0.05) were introduced into unconditional logistic regression analysis. Results The highest proportion of fungal infection occurred in the age group over 60 years old, accounting for 66.50%. The highest proportion of deaths among patients aged >70-80 was 26.67%.Candida infection was the main cause of fungal infection, accounting for 88.04%. The infection site of fungal was the first in lung infection, accounting for 47.6%. Invasive Candida albicans infection accounted for the highest proportion, accounting for 47.07%. Univariate chi-square test for risk factors showed that 9 variables were the risk factors of fungal infection(P<0.05).Incorporating 9 variables into unconditional logistic regression analysis, according to the value of OR, they were the species of antibiotics use, age, whether living in ICU, invasive operation and hospitalization. Conclusion Strengthening the protective isolation measures for elderly patients, strengthening the disinfection and isolation of the ward environment, strengthening the pathogenic monitoring for the elderly and patients undergoing invasive operation and strict control of the use of antibiotics can help control fungal infections in hospitals.