成人免疫性血小板减少症患者糖皮质激素治疗期发生院内感染的危险因素分析

Risk Factors of Nosocomial Infection during Glucocorticoid Therapy in Adult Patients with Immune Thrombocytopenia

目的:分析成人免疫性血小板减少症(ITP)患者糖皮质激素治疗期发生院内感染的病原菌和相关危险因素。方法:选取2016年1月-2021年1月本院收治并确诊的成人ITP患者270例作为研究对象,根据患者是否出现院内感染,将患者分为感染组(22例)和未感染组(248例)。分析糖皮质激素治疗期成人免疫性血小板减少症患者发生医院感染的相关危险因素、感染病原菌的分布和感染部位,并探讨可以采取的防治对策。结果:270例患者发生院内感染22例,感染率为8.15%。两组的住院天数、合并基础疾病、糖皮质激素用量、激素累积用药时间、粒细胞缺乏症比较,差异均有统计学意义(P<0.05)。经多因素分析,粒细胞缺乏症、糖皮质激素用量、激素累积用药时间是ITP成人糖皮质激素治疗期出现医院感染的独立危险因素(P<0.05)。感染部位包括呼吸道、胃肠道、皮肤软组织、血管相关性感染、口腔感染、肛周感染、泌尿系统感染、多部位感染,其中呼吸道感染是最主要的发病部位。感染病原菌有革兰阴性菌(大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、革兰阴性螺形菌)、革兰阳性菌(金黄色葡萄球菌、溶血性葡萄球菌、粪肠球菌)、真菌(白色假丝酵母菌、肺曲霉属菌)。结论:糖皮质激素治疗期成人免疫性血小板减少症患者院内出现感染的比例较高,相关危险因素较多,在治疗期间需要对患者周围环境加强清洁,控制可能出现的感染源,可以预防和降低糖皮质激素治疗期成人ITP患者发生院内感染的概率。

Objective:To analyze the pathogenic bacteria and risk factors of nosocomial infection in adult patients with immune thrombocytopenia(ITP)during glucocorticoid therapy.Method:A total of 270 adult ITP patients admitted to our hospital from January 2016 to January 2021 were selected as the study subjects.According to whether the patients had nosocomial infection,the patients were divided into the infected group(22 cases)and the non-infected group(248 cases).The risk factors of nosocomial infection in adult patients with immune thrombocytopenia during glucocorticoid treatment,the distribution of pathogenic bacteria and the site of infection were analyzed,and the prevention and treatment measures was explored.Result:Nosocomial infection occurred in 22 of 270 patients,and the infection rate was 8.15%.There were statistically significant differences in hospitalization days,combined underlying diseases,glucocorticoid dosage,hormone cumulative duration,agranulocytosis between the two groups(P<0.05).Infection sites included respiratory tract,gastrointestinal tract,skin and soft tissue,vascular-related infection,oral infection,perianal infection,urinary system infection and multi-site infection,among which respiratory tract infection was the most important site;The pathogens of infection included Gram-negative bacteria(Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Gram-negative spirochetes),Gram-positive bacteria(Staphylococcus aureus,Staphylococcus hemolytic,Enterococcus faecalis),and fungi(Candida albicans,Pulmonary aspergillus).Conclusion:The proportion of nosocomial infection in adult patients with immune thrombocytopenia during glucocorticoid treatment is high,and there are many related risk factors.During treatment,it is necessary to strengthen the cleaning of the patient’s surrounding environment and control the possible source of infection,which can prevent and reduce the probability of nosocomial infection in adult ITP patients during glucocorticoid treatment.