呼吸内科使用无创呼吸机患者发生院内感染的病原学特征与危险因素分析

Etiological Characteristics and Risk Factors of Nosocomial Infection in Patients Using Noninvasive Ventilator in Respiratory Department

目的:探讨呼吸内科经无创呼吸机治疗后并发院内感染的病原学体征和危险因素。方法:选择2016年5月~2019年5月呼吸内科收治患者357例作为对象,所有患者均采用无创呼吸机治疗(呼吸机型号:西门子servo-s、servo-i Vela PB840)。查阅患者病历资料,了解患者院内感染的病原学特征,并完成多因素Logistic分析。结果:呼吸内科经无创呼吸机治疗患者的感染率为28.57%,多为上/下呼吸道感染,感染率占比为25.49%/40.20%。病原菌主要为革兰阴性菌(74.54%),具体为鲍曼不动杆菌和铜绿假单胞菌等。抗菌药物应用率最高的是左氧氟沙星(23.11%),其次为头孢噻肟/舒巴坦(21.04%)。单因素及多因素Logistic回归分析结果表明:影响院内感染的危险因素有住院时间长于10d、置导管、合并恶性肿瘤。结论:呼吸内科使用无创呼吸机治疗患者发生院内感染率较高,且院内感染多为上/下呼吸道感染为主,病原菌多是革兰阴性菌,其危险因素较多,应针对危险因素采取干预措施,降低感染率。

Objective:To explore the pathogenic signs and risk factors of nosocomial infection after noninvasive ventilator treatment in respiratory department.Methods:357 patients in respiratory department from May 2016 to may 2019 were selected as subjects.All patients were treated with noninvasive ventilator(ventilator model:Siemens servo-s,servo-i Vela PB840).Consult the patient’s medical records,understand the etiological characteristics of nosocomial infection,and complete multivariate Logistic analysis.Results:In the Department of Respiratory Medicine,the infection rate of patients treated with non-invasive ventilator was 28.57%,most of which were upper/lower respiratory tract infections,and the infection rate accounted for 25.49%/40.20%.The pathogenic bacteria are mainly Gram-negative bacteria(74.54%),specifically Acinetobacter baumannii and Pseudomonas aeruginosa.Levofloxacin(23.11%)has the highest application rate of antibacterial drugs,followed by cefotaxime/sulbactam(21.04%).The results of univariate and multivariate Logistic regression analysis showed that the risk factors affecting nosocomial infection were hospitalization longer than 10 days,catheter placement,and malignant tumors.Conclusion:The nosocomial infection rate of patients treated with noninvasive ventilator in respiratory department is high,and the nosocomial infection is mainly upper/lower respiratory tract infection.The pathogens are mostly Gram-negative bacteria,and there are many risk factors.Intervention measures should be taken according to the risk factors to reduce the infection rate.