急诊科重症患者院内感染临床特征分析

Investigation of nosocomial infections in critical patients in the Emergency Department

目的分析急诊科重症患者院内感染情况,为临床抗感染预防和治疗提供参考。方法收集378例急诊科重症患者临床样本,对患者院内感染情况进行分析。采用全自动细菌鉴定仪对患者感染病原菌类型进行鉴定,并对主要病原菌耐药基因分布情况进行检测。数据采用统计学分析。结果感染104例,感染率27.51%。感染部位为呼吸道、手术切口、消化道、泌尿系统、皮肤、腹腔、口腔及其他部位的患者分别占39.42%、18.27%、14.42%、10.58%、7.69%、1.92%、1.92%和5.77%。发病原因为血管疾病、严重外伤、休克、中毒、消化道出血、气胸、中暑、其他发病原因的患者感染率分别为35.48%、32.26%、29.82%、22.45%、20.45%、18.18%、15.79%和23.81%。接受深静脉置管、导尿、吸氧机、气管插管、呼吸机、内镜观察、腹腔穿刺、其他的感染患者感染率分别为40.21%、30.99%、28.89%、18.13%、15.09%、14.47%、13.54%和17.31%。≥65岁、应用抗菌药物或激素、有多部位病变、住院时间≥7 d等患者感染率较高,差异均有统计学意义(P均<0.05)。从104例感染患者中分离79株病原菌。其中革兰阴性菌、革兰阳性菌、真菌分别为41、25和13株,分别占51.90%、31.65%和16.46%。19株铜绿假单胞菌中,mexT基因突变、nfxB基因突变和IMP基因突变数量分别为5、5和4株。其中mexT基因突变型为L26V,nfxB基因突变型为R82L,IMP基因突变型为A640G和S214G。结论呼吸道是患者感染的主要部位,血管疾病是感染发生的主要病因。接受侵入性操作治疗的患者感染率均较高,尤其是接受深静脉置管的患者,应给予重视。年龄、抗菌药物或激素应用、多部位病变及住院时间是影响患者感染发生的主要因素。革兰阴性菌是主要感染类型,且以铜绿假单胞菌居多,积极监测耐药基因流行情况对感染流行及耐药性传播控制具有重要意义。

Objective To investigate nosocomial infections in critical patients in the Emergency Department in order to guide the clinical prevention and treatment of infections.Methods Clinical samples were collected from 378 patients with a severe condition in the Emergency Department,and the prevalence of a nosocomial infection was analyzed.An automated microbial identification system was used to identify the types of pathogens infecting patients and to detect the distribution of drug resistance genes in the main pathogens.The data were analyzed statistically.Results Of the 378 patients,104 had an infection for a rate of infection of 27.51%.The site of infection was the respiratory tract in 39.42%of patients,a surgical site in 18.27%,the digestive tract in 14.42%,the urinary tract in 10.58%,the skin in 7.69%,the abdominal cavity in 1.92%,the oral cavity in 1.92%,and some other site in 5.77%.The rate of infection was 35.48%in patients with a vascular disease,32.26%in those with severe trauma,29.82%in those in shock,22.45%in those with poisoning,20.45%in those with gastrointestinal bleeding,18.18%in those with pneumothorax,15.79%in those with heatstroke,and 23.81%in those seen for some other cause.The rate of infection was 40.21%in patients who underwent deep venous catheterization,30.99%in those who underwent urinary catheterization,28.89%in those using an oxygen inhaler,18.13%in those who underwent endotracheal intubation,15.09%in those on a ventilator,14.47%in those who underwent endoscopy,13.54%in those who underwent peritoneocentesis,and 17.31%in those who underwent some other procedure.The rate of infection was higher in patients>65 years of age,patients receiving antibiotics or hormones,patients with multiple lesions and patients hospitalized>7 days;the rate of infection differed significantly(P<0.05).Seventy-nine strains of pathogens were isolated from the 104 patients with an infection.Pathogens consisted of 41 strains(51.90%)of Gram-negative bacteria,25 strains(31.65%)of Gram-positive bacteria,and 13 strains(16.46%)of fungi.Nineteen strains of Pseudomonas aeruginosa were found to have 5 mutations in the mexT gene,5 in the NfxB gene,and 4 in the IMP gene.The types of mutations were L26V in mexT,R82L in NfxB,and A640G and S214G in IMP.Conclusion The respiratory tract was the main site of infection and vascular disease was the main cause of infection.Patients who underwent invasive surgery had a high rate of infection,and this was especially true for those undergoing deep venous catheterization.Age,use of antibiotics or hormones,multiple lesions,and the duration of hospitalization were the main factors affecting the incidence of infection.Gram-negative bacteria were the main pathogens causing an infection,and P.aeruginosa was prevalent.Active monitoring of the prevalence of drug resistance genes is of great significance to outbreaks of infection and the control of the spread of drug resistance.