神经内科医院感染患者病原学分布特征、耐药性和危险因素分析

The distributional characteristics of pathogen,drug resistance and risk factors in patienttts with nosocomial infection in department of neurology

目的研究神经内科医院感染患者病原学分布特征、耐药性和相关危险因素,为临床用药提供参考依据。方法选取神经内科2015年1180例住院患者为研究对象,对确诊为医院感染的60例患者送检的临床标本进行培养、菌株鉴定和药敏实验。结果本次研究收集1180例神经内科住院患者中有60例发生医院感染,感染率为5.08%(60/1180)。感染部位中发生呼吸道感染28例(46.67%);泌尿系统感染15例(25.00%);消化系统感染8例(13.33%);血液系统感染6例(10.00%)。60例医院感染患者共分离出病原菌76株,其中革兰阴性菌42株,占55.26%,革兰阳性菌30株,占39.47%,真菌4株,占5.26%。革兰阴性菌中以铜绿假单胞菌和肺炎克雷伯菌为主,分别占19.74%、15.79%;革兰阳性菌中以金黄色葡萄球菌为主,占15.79%;真菌中以白色假丝酵母菌为主,占3.95%。铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌对常用抗生素均存在不同程度耐药。通过分析发现,神经内科住院患者医院感染与患者年龄、住院时间、意识障碍、合并基础疾病、侵入性操作密切相关(P<0.05)。结论神经内科住院患者发生医院感染的病原体分布较广,主要以革兰阴性菌为主,且对常用抗生素存在不同程度耐药。患者年龄、住院时间、意识障碍、合并基础疾病、侵入性操作是感染发生的独立危险因素。

Objective To investigate the distributional characteristics of pathogen,drug resistance and risk factors in patienttts with nosocomial infection in department of neurology,so as to provide favorable evidence for clinical medication.Methods The clinical data of 1180 inpatients in department of neurology in our hospital from Jan 2015 to Dec 2015 were retrospectively analyzed,of whom,the 60 patients were diagnosed as nosocomial infection,and the distributional characteristics of pathogen,drug resistance and risk factors were analyzed.Results Among the 1,180 patients,there were 60 cases of nosocomial infection,with the incidence rate of nosocomial infection being 5.08%(60/1,180).Of the 60 patients with nosocomial infection,the site of infection was mainly in the respiratory tract(28 cases,46.67%),and the other sites of infection were urinary tract(15 cases,25.00%),gastrointestinal tract(8 cases,13.33%)and the blood(6 cases,10.00%).A total of 76 strains of pathogens were isolated from the patients with the infections,42 strains(55.26%)were gram-negative bacteria,30 strains(39.47%)were gram positive bacteria,and 4 strains(5.26%)were fungi.The most detected gram-negative bacteria were Pseudomonas aeruginosa and Klebsiella pneumoniae,accounting for 19.74%(15/76)and 15.79%(12/76),respectively,and 2 strains(15.79%)of gram-positive bacteria were mainly Staphylococcus aureu.The gram-negative bacteria and gram-positive bacteria causing the infection varied in the drug resistance to multiple antibiotics.The analysis showed that patient’s age,hospitalization days,disturbance of consciousness,combination with multiple diseases and invasive procedures were related factors for hospital infection.Conclusion The pathogens that cause nosocomial infection in the hospitalized patients of neurology department are mainly gram-negative bacteria,which exist drug resistance to the common antibiotics at different extents.And patient’s age,hospitalization days,disturbance of consciousness,combination with multiple diseases and invasive procedures are the independent risk factors for the incidence of nosocomial infection.