综合重症监护病房老年患者医院感染现状及危险因素分析

Analysis of nosocomial infection status and risk factors of elderly patients in comprehensive intensive care unit

目的了解综合重症监护病房(intensive care unit,ICU)老年患者医院感染现状,探讨老年患者发生医院感染的危险因素。方法回顾性调查2015年1月-2019年6月期间在上海市某三甲医院综合ICU内年龄≥ 65岁的老年住院患者发生医院感染的情况,分析主要感染类型和检出病原菌种类,采用病例对照研究方法 ,比较医院感染者和非感染者的相关资料,分析发生医院感染的危险因素。结果该ICU患者医院感染发生率为22.0%。主要感染类型是医院获得性肺炎(与导管无关)、呼吸机相关肺炎和导尿管相关尿路感染,构成比分别为28.6%、26.4%和13.2%;主要病原菌是鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌,构成比分别为23.5%、12.7%和12.0%。多因素Logistic回归分析发现,发生医院感染的独立危险因素包括手术(OR=3.405)、血管介入手术(OR=5.656)、抗菌药物使用时间>2周(OR=7.455)、先后使用3类及3类以上抗菌药物(OR=2.818)和住院时间>25d (OR=5.351)。结论综合ICU老年患者发生医院感染以医院获得性肺炎最为常见,其病原菌种类多样,应针对医院感染的危险因素采取相应的预防控制措施,以降低感染的发生率。

Objective To investigate the current status of nosocomial infection in elderly patients in comprehensive intensive care unit(ICU)and to explore the risk factors of nosocomial infection in elderly patients.Methods The nosocomial infection in elderly inpatients aged 65 years or above in the Comprehensive ICU of a tertiary hospital in Shanghai fromJanuary 2015 to June 2019 was investigated retrospectively,and the main types of infection and the pathogenic species were analyzed.A case-control study was conducted to compare the data of patients with and without nosocomial infection,and to analyze the risk factors of nosocomial infection.Results The incidence of nosocomial infection in these patients was 22.0%.The main infection types were hospital acquired pneumonia(not related to catheters),ventilator-associated pneumonia and catheter-associated urinary tract infection,accounting for 28.6%,26.4%and 13.2%,respectively.The main pathogens were acinetobacter baumannii,klebsiella pneumoniae and pseudomonas aeruginosa,accounting for 23.5%,12.7%and 12.0%,respectively.Multivariate logistic regression analysis showed that the independent risk factors of nosocomial infection included surgery(OR=3.405),vascular interventional surgery(OR=5.656),duration of antibiotic use>2 weeks(OR=7.455),use of three or more kinds of antibiotics(OR=2.818)and length of hospital stay>25 days(OR=5.351).Conclusion Hospital acquired pneumonia is the most common nosocomial infection in elderly patients in comprehensive ICU.There are many kinds of pathogens that cause nosocomial infection.Corresponding preventive and control measures should be taken for the risk factors of nosocomial infection to reduce the incidence of infection.