急诊科重症患者医院感染病原菌及其影响因素

Pathogenic bacteria distribution and influencing factors for nosocomial infection in severe patients in the emergency department

目的分析急诊科重症患者发生医院感染的现状、病原菌分布情况,并调查其高危因素。方法2019年6月-2022年9月丽水市中心医院急诊科重症患者198例纳入研究,回顾性收集患者临床资料,根据医院感染发生情况分别纳入医院感染组36例,无医院感染组162例。分析急诊科重症患者医院感染现状,病原菌分布,通过单因素、多因素分析急诊科重症医院感染的高危因素。结果198例急诊科重症患者发生医院感染36例,发生率为18.18%,主要感染部位为患者下呼吸道、胃肠道、泌尿系统,占比分别为41.67%、19.44%、13.89%;36例急诊科重症医院感染患者共分离出病原菌42株,其中革兰阴性菌占比57.14%,革兰阳性菌占比30.95%,真菌占比11.90%;多因素Logistic分析结果显示,急诊手术、气管插管或气管切开为急诊科重症医院感染的风险因素(P<0.05),病房每天消毒次数≥2次为急诊科重症医院感染的保护因素(P<0.05)。结论急诊科重症患者发生医院感染率较高,主要感染部位为患者下呼吸道、胃肠道、泌尿系统,病原菌以革兰阴性菌为主,其发生与多种因素有关,临床可对高危患者进行针对性干预,进而预防急诊科重症医院感染的发生。

OBJECTIVE To analyze the status of nosocomial infection in severe patients in the emergency depart-ment and the distribution of pathogenic bacteria,and to investigate the risk factors.METHODS From Jun 2019 to Sep 2022,198 severe patients in the emergency department of Lishui Central Hospital were included in the stud-y.Clinical data of patients were retrospectively collected.According to whether nosocomial infection occurred,they were divided into the nosocomial infection group(36 cases)and the nosocomial infection group(162 cases).The nosocomial infection status and pathogen distribution in severe patients in the emergency department was ana-lyzed,and the high risk factors for nosocomial infection in emergency department were investigated by univariate and multivariate analysis.RESULTS There were 36 cases of nosocomial infection in 198 severe patients in the e-mergency department,and the incidence rate was 18.18%.The main infection sites were lower respiratory tract,gastrointestinal tract and urinary system,accounting for 41.67%,19.44%and 13.89%,respectively.A total of 42 strains of pathogenic bacteria were isolated from 36 patients with severe nosocomial infection in the emergency department,among them,gram-negative bacteria accounted for 57.14%,gram-positive bacteria accounted for 30.95%,and fungi accounted for 11.90%.Multivariate logistic analysis showed that the risk factors for severe nosocomial infection in the emergency department were emergency operation,tracheal intubation or tracheotomy(P<0.05),ward disinfection times≥2 times/d was protective factor for severe nososoial infection in the emer-gency department(P<0.05).CONCLUSION The nosocomial infection rate of severe patients in the emergency department is high,and the main infection sites are the lower respiratory tract,gastrointestinal tract and urinary system of patients.The pathogenic bacteria are mainly gram-negative bacteria,and its occurrence is related to vari-ous factors.Targeted intervention could be carried out in high-risk patients to prevent the occurrence of severe nos-ocomial infection in the emergency department.