2014-2018年西南医科大学附属医院重症监护患者医院感染现状及影响因素分析

Analysis of Nosocomial Infection and its Influencing Factors of Patients in the ICU of Affiliated Hospital of Southwest Medical University

目的调查2014-2018年西南医科大学附属医院重症监护(intensive care unit,ICU)患者医院感染的现状,探寻其影响因素,为预防和降低ICU医院感染提供参考依据。方法以2014-01/2018-12间西南医科大学附属医院ICU收治的患者为调查对象,从医院诊疗系统和医院感染报告卡收集患者的一般信息、临床信息及医院感染相关信息,采用卡方检验和多因素Logistic回归进行统计分析。结果本次研究纳入5 121例ICU患者,平均病情严重程度评分(ASIS评分)均分为3.58分,ICU患者医院感染发生率为20.54%,日医院感染发生率为1.79%。2014-2018年间ICU患者医院感染发生率分别为19.88%、20.54%、19.21%、20.98%和21.99%,不同年度间的感染率差异无统计学意义(χ^2=2.809,P=0.590)。ICU患者医院感染发生的部位主要为下呼吸道(64.91%),其次为泌尿道(18.86%),最低为皮肤创面(3.08%);ICU患者医院感染病原菌以革兰阴性菌主(54.39%),其中17.11%为铜绿假单胞菌;革兰阳性菌占34.21%,其中15.79%为金黄色葡萄球菌;真菌占11.40%,其中8.77%为酵母菌属;多因素Logistic回归分析显示,显示年龄≥60岁者医院感染发生率是<60岁者的2.17倍(95%CI:1.43~8.56),接受侵入性操作者医院感染发生率是未接受侵入性操作者的2.84倍(95%CI:1.57~9.38),ASIS评分≥4分者医院感染发生率是ASIS评分<4分者1.63倍(95%CI:1.22~3.26),住院时间为≥10天者发医院感染发生率是住院时间<10天者的2.96倍(95%CI:1.79~10.42),控制其他因素后,未见抗菌药物的使用对医院感染发生率产生影响(P>0.05)。结论 ICU医院感染发生率处于较高水平,防控形势严峻,需持续完善医院感染的综合性监测和目标性监测体系,掌握危险因素,加强监测频度和力度,以减少ICU患者医院感染的发生。

Objective To investigate the nosocomial infection and its influencing factors of patients treated in the Intensive Care Unit(ICU)at the Affiliated Hospital of Southwest Medical University,to improving the reference for preventing and reducing hospital infection in ICU.Methods From January 2014 to December 2018,patients who were treated in the ICU of Affiliated Hospital of Southwest Medical University were selected as survey objects.General information,clinical information and nosocomial infection-related information were collected from hospital diagnosis and treatment system and nosocomial infection report card.Chi-square test and multifactor logistics regression analysis were used for statistical analysis.Results A total of 5121 patients in ICU were investigated,with an average ASIS score of 3.58.The incidence of nosocomial infection in ICU patients was 20.54%,and the daily incidence of notarization was 1.79%.From 2014 to 2018,the ICU infection rate was 19.88%,20.54%,19.21%,20.98%and 21.99%,respectively.There was no statistically significant difference in ICU infection rate between different years(χ2=2.809,P=0.590).The infection mainly occurred in the lower respiratory tract(64.91%),followed by the urinary tract(18.86%),and the lowest was the skin wound(3.08%).The pathogenic bacteria of nosocomial infection of patients in ICU were mainly gram negative bacteria(54.39%),among which 17.11%were pseudomonas aeruginosa.Gram-positive bacteria accounted for 34.21%,15.79%of which were staphylococcus aureus.Fungi accounted for 11.40%,among which 8.77%were yeast.Multifactor logistics regression analysis showed that the incidence of nosocomial infection in patients aged≥60 was 2.17 times that in aged<60(95%CI:1.43~8.56),the incidence of nosocomial infection in patients with invasive operators was 2.84 times that in patients with non-invasive operators(95%CI:1.57~9.38),the incidence of nosocomial infection in patients with ASIS score≥4 was 1.63 times that in ASIS score<4(95%CI:1.22~3.26).Conclusion The incidence of nosocomial infection in ICU was at a high level,and the situation of prevention and control was severe.It was necessary to continuously improve the comprehensive and targeted monitoring system of nosocomial infection,master risk factors,and strengthen the frequency and intensity of monitoring,so as to reduce the incidence of nosocomial infection in ICU.