脑梗死患者医院感染特点及危险因素

Characteristics and risk factors for nosocomial infection in patients with cerebral infarction

目的探讨脑梗死患者医院感染特点及其危险因素。方法选取2016年1月-2019年12月鹰潭市人民医院神经内科合并医院感染的脑梗死患者74例作感染组,收集患者临床疾病资料、检查资料及病原学资料,总结脑梗死患者医院感染特点;另选取同期未发生医院感染的脑梗死患者65例作无感染组,以非条件Logistic模型,分析脑梗死患者发生医院感染的危险因素。结果脑梗死医院感染患者中≥60岁占87.84%,感染部位以下呼吸道为主(66.22%),病原菌培养阳性率为77.03%,共分离出65株病原菌,以革兰阴性菌为主(58.46%),常见革兰阴性菌对万古霉素、美洛培南及亚胺培南耐药率低。Logistic回归分析显示,年龄(OR=1.545)、吞咽困难(OR=1.435)、既往肺部疾病(OR=1.425)、糖尿病(OR=1.684)、入院美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.799)、住院时间(OR=1.919)及侵入性操作(OR=1.751)是脑梗死患者发生医院感染的独立危险因素(P<0.05)。结论老年脑梗死患者是医院感染的易感人群,多为下呼吸道感染,病原菌以革兰阴性菌为主,其发生医院感染的影响因素较多,需针对性制定相应预防及干预对策,以降低脑梗死患者医院感染发生率。

OBJECTIVE To explore the characteristics and risk factors for nosocomial infection in the patients with cerebral infarction.METHODS A total of 74 cerebral infarction patients complicated with nosocomial infection who were treated in Yingtan People’s Hospital from Jan 2016 to Dec 2019 were enrolled in the study and set as the infection group.The clinical data of diseases,examination data and etiological data were collected from the patients,the characteristics of nosocomial infection in the patients were summarized.Meanwhile,65 cerebral infarction patients who did not have nosocomial infection were chosen as the non-infection group,and non-conditional logistic model was established to analyze the risk factors for the nosocomial infection in the patients with cerebral infarction.RESULTS Among the cerebral infarction patients with nosocomial infection,the patients who were more than 60 years old accounted for 87.84%,the patients with lower respiratory tract infection accounted for 66.22%.The positive rate of culture of pathogens was 77.03%.Totally 65 strains of pathogens were isolated,58.46%of which were gram-negative bacteria.The drug resistance rates of the common gram-negative bacteria to vancomycin,meropenem and imipenem were low.Logistic regression analysis showed that the age(OR=1.545),dysphagia(OR=1.435),previous lung diseases(OR=1.425),diabetes(OR=1.684),NIHSS score at admission(OR=1.799),hospitalization time(OR=1.919)and invasive operation(OR=1.751)were the independent risk factors for the nosocomial infection in the patients with cerebral infarction(P<0.05).CONCLUSION The elderly patients with cerebral infarction are the population at high risk of nosocomial infection,most of whom have lower respiratory tract infection.The gram-negative bacteria are dominant among the pathogens.There are a variety of influencing factors for the nosocomial infection.It is necessary to take targeted intervention countermeasures so as to reduce the incidence of nosocomial infection in the patients with cerebral infarction.