缺血性脑卒中患者发生医院感染的相关因素及感染部位、病原菌特点

Related Factors of the Occurrence of Nosocomial Infection in Patients with Ischemic Stroke and Infection Site,Characteristics of Pathogenic Bacteria

目的:研究缺血性脑卒中患者发生医院感染的相关因素及感染部位、病原菌特点。方法:回顾性分析2020年1-10月在本院治疗的1096例缺血性脑卒中患者的临床资料,其中有32例患者出现医院感染,发生率为2.92%。将缺血性脑卒中合并医院感染的32例患者作为研究组,1064例未感染患者作为对比组。分析影响缺血性脑卒中患者发生医院感染的相关危险因素,并统计研究组感染部位和病原菌特点。结果:经单因素分析,两组年龄、吸烟史、糖尿病史、机械通气治疗、意识障碍、多脏器衰竭比较差异有统计学意义(P<0.05);两组抗菌药使用、住院时间、饮酒史、高血压史比较差异无统计学意义(P>0.05)。经多因素分析,患者年龄>65岁和存在吸烟史、糖尿病史、机械通气治疗、多脏器衰竭、意识障碍是缺血性脑卒中患者发生医院感染的独立危险因素(P<0.05)。缺血性脑卒中合并医院感染患者的感染部位主要在呼吸道,发生率为62.50%(20/32),其余依次为泌尿道、口腔、皮肤软组织、其他部位。32例医院感染患者标本共检出57株病原菌,分离菌株数量最多的标本为痰液(30株,占52.63%),其余依次为尿液(10株,占17.54%)、血液(7株,占12.28%)、灌洗液(4株,占7.02%)、脓液(3株,占5.26%)、分泌物(2株,占3.51%)、其他标本(1株,占1.75%);57例菌株有30株革兰阴性杆菌,15例革兰阳性球菌,12例真菌。结论:缺血性脑卒中合并医院感染的感染部位主要发生在呼吸道,尤其是下呼吸道,而病原菌则常见于革兰阴性杆菌,年龄>65岁、吸烟史、糖尿病史、机械通气治疗、多脏器衰竭、意识障碍是缺血性脑卒中患者发生医院感染的危险因素,临床应根据上述诱发因素采取针对性措施,降低医院感染发生率。

Objective:To study the related factors of the occurrence of nosocomial infection in patients with ischemic stroke and infection site,characteristics of pathogenic bacteria.Method:The clinical data of 1096 patients with ischemic stroke treated in our hospital from January to October 2020 were retrospectively analyzed.Among them,32 patients developed nosocomial infection,the incidence was 2.92%,32 cases of ischemic stroke with nosocomial infection were enrolled as the study group;the remaining 1064 uninfected patients were enrolled as the control group.The risk factors affecting nosocomial infection in patients with ischemic stroke were analyzed,and the characteristics of infection sites and pathogens were analyzed.Result:By univariate analysis,there were statistically significant differences between the two groups in age,smoking history,diabetes history,mechanical ventilation treatment,consciousness disorder and multiple organ failure(P<0.05);there were no significant difference in the use of antibiotics,hospitalization time,drinking history and hypertension history between the two groups(P>0.05).By multivariate analysis,age>65 years old,history of smoking,diabetes,mechanical ventilation treatment,multiple organ failure,and consciousness disorder were independent risk factors for nosocomial infection in patients with ischemic stroke(P<0.05).The infection sites of ischemic stroke patients with nosocomial infection were mainly in respiratory tract,the incidence rate was 62.50%(20/32),the rest were urinary tract,oral cavity,skin and soft tissue,and other parts.Fifty-seven strains of pathogenic bacteria were detected in 32 cases of nosocomial infection,sputum(30 strains,52.63%)were the most isolated strains,the rest were urine(10 strains,17.54%),blood(7 strains,12.28%),lavage fluid(4 strains,7.02%),pus(3 strains,5.26%),secretion(2 strains,3.51%),other samples(1 strain,1.75%).Among the 57 strains,30 strains were Gram-negative bacilli,15 strains were Gram-positive cocci,and 12 strains were fungal.Conclusion:The infection site of ischemic stroke with nosocomial infection mainly occurred in respiratory tract,especially in lower respiratory tract,while the pathogenic bacteria were common in Gram-negative bacilli.Age,smoking history,diabetes history,mechanical ventilation treatment,multiple organ failure and consciousness disorder were the risk factors of nosocomial infection in patients with ischemic stroke,so we should take targeted measures according to the above-mentioned inducing factors measures to reduce the incidence of nosocomial infection.