骨科住院患者医院感染特点与危险因素分析

Nosocomial infection characteristics and risk factors analysis of orthopedic inpatients

目的分析骨科住院患者医院感染的临床特征与危险因素,为降低骨科医院感染发生率提供科学依据。方法选取2017年9月1日~2018年8月31日于我院骨科住院的3542例患者作为监测对象,将其分为创伤(1295例)、关节(1075例)、脊柱(1172例)三个专业组,分析骨科住院患者医院感染的临床特点及危险因素。结果骨科住院患者医院感染发生率(例次发生率)为1.67%(1.89%);创伤组的医院感染例次发生率为2.93%,高于关节组的1.58%和脊柱组的1.02%,差异有统计学意义(P<0.05)。医院感染部位构成前3位为下呼吸道(32.84%)、手术部位(31.34%)、泌尿道(20.90%);病原菌中革兰阴性菌、革兰阳性菌、真菌分别占50.00%、46.00%、4.00%,前3位病原菌为金黄色葡萄球菌(24.00%)、大肠埃希菌(20.00%)、鲍曼不动杆菌(12.00%)。感染者与未感染者的年龄≥65岁、性别、低蛋白血症、基础疾病≥2种、牵引制动、手术、使用呼吸机、入住ICU、中心静脉置管、留置尿管情况比较,差异有统计学意义(P<0.05);进一步多因素非条件Logistic回归分析显示,男性、低蛋白血症、基础疾病≥2种、入住ICU、中心静脉置管、留置尿管为骨科患者医院感染的独立危险因素(P<0.05)。结论骨科住院患者医院感染具有以下呼吸道和手术部位感染为主、革兰阴性菌及革兰阳性菌感染比例相当、创伤患者医院感染率较高的特点,存在上述一种或多种危险因素的骨科住院患者发生医院感染风险较大,应积极治疗低蛋白血症、基础疾病,规范并减少侵入性操作等,以降低医院感染率。

Objective To analyze the clinical characteristics and risk factors of nosocomial infection in hospitalized patients in orthopedic department,so as to provide scientific basis for reducing the incidence of nosocomial infection in orthopedic.Methods A total of 3542 patients who hospitalized in the orthopedic department from September 1,2017 to August 31,2018 in our hospital were selected as the monitoring objects and divided into three specialized groups:the trauma group(1295 cases),the joint group(1075 cases)and the spine group(1172 cases).The clinical characteristics and risk factors of nosocomial infection in orthopedic inpatients were analyzed.Results The incidence rate of nosocomial infection of orthopedic inpatients was 1.67%(the case number infection rate was 1.89%).The incidence rate of case number nosocomial infection in the trauma group was 2.93%,which was higher than that in the joint group(1.58%)and spine group(1.02%),the differences were statistically significant(P<0.05).The top three infection sites were lower respiratory tract(32.84%),surgical site(31.34%)and urinary tract(20.90%).Gram-negative bacteria,gram-positive bacteria and fungi accounted for 50.00%,46.00%,and 4.00%,respectively.The top three pathogens were Staphylococcus aureus(24.00%),Escherichia coli(20.00%)and Acinetobacter baumannii(12.00%).The differences between the infected and uninfected patients in age(over 65 years old),gender,hypoproteinemia,basic diseases(more than 2 kinds),traction brake,surgery,use of ventilator,admission to ICU,central vein catheterization and indwelling catheter were statistically significant(P<0.05).Further multivariate unconditional Logistic regression analysis showed that male,hypoproteinemia,basic diseases(more than 2 kinds),admission to ICU,central vein catheterization and indwelling catheter were independent risk factors of nosocomial infection in orthopedic patients(P<0.05).Conclusion The nosocomial infection of orthopedic inpatients has the following characteristics:the mainly infection sites are lower respiratory tract and surgical site,the proportion of gram-negative bacteria and gram-positive bacteria is similar,and the nosocomial infection rate in trauma patients is higher.The risk of nosocomial infection of orthopedic inpatients with one or more of the above risk factors is higher.The hypoproteinemia and basic diseases should be actively treated,and invasive operation should be standardized and reduced,in order to reduce the nosocomial infection rate.