呼吸内科使用无创呼吸机患者发生院内感染的病原学特征与危险因素分析

Analysis of the pathogenic characteristics and risk factors of nosocomial infection in patients with non invasive ventilator in the respiratory medicine department

目的:分析使用无创呼吸机患者发生医院感染的病原学特征与危险因素,为临床治疗与预防院内感染发生提供理论指导。方法:回顾性分析2015年1月—2018年12月南通市第三人民医院呼吸内科收治的因呼吸系统疾病使用无创呼吸机患者325例,查阅住院病历,记录医院感染率、感染部位、病原菌分布与药敏试验、抗菌药物使用构成比,采用Logistic回归分析影响医院感染的相关因素。结果:使用无创呼吸机患者325例的医院感染率为29.85%;医院感染部位以上、下呼吸道感染为主,感染率分别为25.77%与44.33%;医院感染病原菌以革兰阴性菌为主,占74.26%,主要包括鲍曼不动杆菌、铜绿假单胞菌与大肠埃希菌;抗菌药物使用构成中,左氧氟沙星与头孢噻肟/舒巴坦的使用占比最高,分别为23.87%与20.95%;多因素分析显示,住院时间>10 d、有留置导管与恶性肿瘤是无创呼吸机的患者发生医院感染的独立危险因素。结论:医院呼吸内科使用无创呼吸机患者发生医院感染主要以上、下呼吸道感染为主,感染的主要病原菌以革兰阴性菌为主,其中,年龄、抗菌药物的使用、留置导尿管与住院时间是导致该类患者医院感染的独立危险因素。通过对独立危险因素进行分析与干预,可有效预防并减少医院感染的发生。

Objective:To analyze the etiological characteristics and risk factors of nosocomial infections in non-invasive ventilator patients in respiratory department of the hospital,so as to provide theoretical guidance for clinical treatment of such patients and prevention of nosocomial infections.Methods:A retrospective analysis of 325 cases of choice frpm January 2015 to December 2018 in the hospital of respiratory medicine from respiratory diseases due to the use of noninvasive ventilation in patients through access to medical records,records of patients with hospital infection rate,infection sites,pathogenic bacteria distribution and drug sensitivity test,the constituent ratio of antibacterial drugs,and the influence of the related factors of hospital infection in return analysis by Logistic.Results:The survey of respiratory medicine,325 cases of the use of noninvasive ventilation in patients,the hospital infection rate was 29.85%;located in the upper and lower respiratory tract infection.The hospital infection,the infection rates were 25.77%and 44.33%;nosocomial infection pathogens are Gram-negative bacteria,accounting for 74.26%,including Bauman Acinetobacter,Pseudomonas aeruginosa and Escherichia coli coli;antibiotic use of levofloxacin and cefotaxime/sulbactam with the highest proportion,respectively 23.87%and 20.95%;multivariate analysis showed that hospitalization time,indwelling catheter and 10 d and malignant tumor are independent risk factors of nosocomial infection in patients with ventilator.Conclusion:The use of non-invasive respiratory medicine hospital nosocomial infection of lower respiratory tract infection,above the main main ventilator,the main pathogens are Gram-negative bacteria,the use of antibacterial drugs,age,indwelling urinary catheter and hospitalization time is the result of independent risk factors for infection of the patients in hospital.Through the analysis and intervention of independent risk factors,we can effectively prevent and reduce the incidence of nosocomial infection.