上海地区143所医院2000～2002年医院下呼吸道感染发病率与相关因素分析

Cohort study of incidence and related factors of nosocomial lower respiratory tract infection in 143 hospitals in Shanghai

目的 了解上海地区医院下呼吸道感染 (NLRTI)的发病率及其相关影响因素。方法 采用回顾性队列研究。以 2 0 0 0年 1月～ 2 0 0 2年 12月上海市医院感染监测网 14 3所二、三级医院的住院病例为研究对象 ,分析NLRTI的发病率及其相关因素。结果 3年间共有 2 89185 9例住院患者 ,发生医院感染 135 2 5 4例 ,发病率为 4 .6 8%。其中NLRTI 4 5 6 89例 ,占医院感染的 33.8%。NLRTI构成比较高的科室为呼吸内科 ( 4 7.7% )和胸外科 ( 4 9.6 % ) ,妇科 ( 8.15 % )和产科 ( 4 .80 % )较低。NLRTI平均发病率为 1.5 8% ,以血液科 ( 5 .0 7% )、神经内科 ( 4 .4 0 % )和神经外科 ( 3.77% )为高 ,妇产科和眼耳鼻喉科则不足 0 .2 0 %。在不同类别医院间 ,NLRTI发病率的差异有显著性 (P <0 .0 0 1) ,以三级综合性医院最高 ( 2 .0 2 % ) ,其余依次为二级综合性医院 ( 1.5 5 % )、三级专科性医院 ( 1.18% )、二级专科医院 ( 0 .6 0 % )。二、三级综合性医院同类科室比较 ,大部分科室NLRTI发病率的差异有显著性 (P <0 .0 5 )。比较不同月份NLRTI发病率 ,结果显示 3～ 7月发病率 ( 1.4 9% )明显低于其他月份 ( 1.6 4 % ) (P <0 .0 0 1)。结论 NLRTI是上海市最常见的医院感染类型。

Objective Objective To find out the incidence and related factors of nosocomial lower tract infection (NLRTI) in Shanghai. Methods A retrospective cohort study was carried out from January 2000 to December 2002, a total of 2 891 859 patients were admitted to 143 hospitals and the related factors of NLRTI were analyzed by Chi squared test and odds ratio. Statistical significance was predetermined including P values of <0.05 . Results The incidence of nosocomial infection was 4.68%, the constituent ratio of NLRTI was 33.8%. The higher constituent ratios were in the departments of respiratory medicine ( 47.7% ), chest surgery (49.6%), the lowest ratios were in the departments of gynecology (8.15%), obstetrics (4.80%). The overall incidence rate of NLRTI was 1.58%, and the higher rates were in the departments of hematology (5.07%), neurology (4.40%), and neurosurgery(3.77%); while the incidences of lower than 0.20% were in the departments of obstetrics, gynecology, ophthalmology and otorhinolaryngology. Among the hospitals, the difference of the incidences was obvious ( P <0.001). The highest incidence was in the tertiary general hospitals (2.02%), followed by the tertiary specialized hospitals (1.55%), secondary general hospitals (1.18%) and secondary specialized hospitals (0.60%). NLRTI was higher during August till the next February ( P <0.001). Conclusion The most frequent type of nosocomial infection in Shanghai is lower respiratory tract infection. The incidence rate of NLRTI in the tertiary general hospitals is higher than that in the other hospitals. The higher incidences of NLRTI are observed in the departments of hematology, neurology, neurosurgery and in the autumn and winter seasons.