老年重症患者医院感染的影响因素

Influencing factors for nosocomial infection in critically ill elderly patients

目的 分析老年重症患者医院感染病原菌分布及耐药性,探究医院感染影响因素,为临床预防感染及合理选择抗菌药物提供参考依据。方法 回顾性分析医院2016年11月-2017年11月收治的330例老年重症患者的临床资料,统计感染病原菌的分布,单因素及多因素Logistics回归分析患者发生医院感染的影响因素。结果 330例老年重症患者共发生医院感染62例,感染率为18.79%。送检标本中共分离出病原菌107株,革兰阳性菌37株占34.58%、革兰阴性菌59株占55.14%、真菌11株占10.28%。多因素Logistics回归分析结果,患者合并糖尿病、心功能分级(NYHA)Ⅲ~Ⅳ级、住院时间≥15d、合并慢性阻塞性肺疾病、进行侵入性操作、意识障碍、呼吸机辅助呼吸、患者营养不良、贫血、低蛋白血症、应用抗菌药物种类≥2种、抗菌药物应用时间≥7d是老年重症患者发生医院感染的独立影响因素(P<0.05)。结论 老年重症患者容易发生医院感染,影响因素较多,选择抗菌药物应当联合使用敏感度较高的药物,并且控制用药时间和避免无指征用药。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infection in critically ill elderly patients and explore the influencing factors for the nosocomial infection so as to provide guidance for clinical prevention of infection and reasonable use of antibiotics.METHODS The clinical data of 330 critically ill elderly patients who were treated from Nov 2016to Nov 2017were retrospectively analyzed,the distribution of the pathogens was statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection.RESULTS Of the 330elderly patients, 62had nosocomial infection,with the infection rate 18.79%.A total of 107strains of pathogens were isolated from the submitted specimens,37(34.58%)of which were gram-positive bacteria,59(55.14%)were gramnegative bacteria,and 11(10.28%)were fungi.The result of multivariate logistic regression analysis indicated that the independent risk factors for the nosocomial infection in the elderly patients included complication with diabetes mellitus,NYHA ranging between gradeⅢandⅣ,length of hospital stay no less than 15days,complication with chronic obstructive pulmonary disease,invasive procedure,disturbance of consciousness,mechanical ventilation, malnutrition,anemia,hypoproteinemia,use of more than 2types of antibiotics and use of antibiotics no less than 7days(P<0.05).CONCLUSIONThe elderly patients are more likely to have nosocomial infection,and there are a variety of influencing factors.It is necessary to choose sensitive antibiotics for combined drug therapy,control the time of use of antibiotics and use antibiotics based on indications.