心房纤颤致脑栓塞患者300例医院感染病原学特征与危险因素分析

Etiological characteristics and risk factors of nosocomial infection in patients with cardiogenic cerebral embolism caused by atrial fibrillation

目的探讨房颤致脑栓塞患者医院感染病原学特征与危险因素,以期为预防医院感染提供参考。方法回顾性分析2012年4月至2015年4月在我院接受治疗的房颤致脑栓塞的患者300例的临床资料,记录所有患者的医院感染率、感染部位、病原菌分布,分析导致房颤并发脑栓塞患者出现医院感染的危险因素。结果 300例房颤并发脑栓塞患者中发生医院感染的感染率为34.0%,其中革兰阴性菌感染297例,占80.0%,革兰阳性菌感染54例,占14.6%,真菌感染20例,占5.4%;感染部位以呼吸道感染为主,共65例,占63.7%,其中上呼吸道感染10例,下呼吸道感染55例,分别占15.4%和84.6%;其次包括泌尿道、胃肠道、皮肤软组织和口腔感染,分别占15.3%、9.2%、6.8%和5.0%。房颤致脑栓塞患者医院感染的主要危险因素年龄、住院时间、意识障碍、滥用抗菌药物和机械通气。结论房颤并发脑栓塞出现医院内感染的主要病原菌为革兰阴性菌,且以下呼吸道感染为主。此外,感染的发生可能与年龄、住院时间、意识障碍、滥用抗菌药物和机械通气等危险因素有关。

Objective To explore the etiological characteristics and risk factors of nosocomial infection in patients with cardiogenic cerebral embolism caused by atrial fibrillation so as to provide guidance for clinical diagnosis and treatment.Methods The clinical data of 300 patients with cardiogenic cerebral embolism caused by atrial fibrillation in our hospital from April 2012 to April 2015 were retrospectively analyzed.Then the risk factors of nosocomial infection were recorded in all patients.The hospital infection rate, infection site, pathogenic bacteria distribution were also recorded.To analyze the risk factors of hospital infection in patients with cardiogenic cerebral embolism caused by atrial fibrillation.Results The nosocomial infection rate in 300 cases of patients undergoing cardiogenic cerebral embolism caused by atrial fibrillation was 34.0%, of which the case of gram-negative bacteria infection was 297, accounting for 80.0%, and the case of gram-positive bacteria infection was 54, accounting for14.6%;the case of fungal infections was 20, accounting for 5.4%;65 cases of infection occured in respiratory tract infections, accounting for 63.7%, of which 10 cases were the upper respiratory tract infection, and 55 cases were the lower respiratory tract infections, accounted for 15.4% and 84.6% respectively;Followed by urinary tract, gastrointestinal tract, skin and soft tissue and oral infection, accounted for 15.3%, 9.2%, 6.8% and 5.0%, respectively.The main risk factors of nosocomial infection in patients with cardiogenic cerebral embolism caused by atrial fibrillation includes age, underlying diseases, hospitalization time, disturbance of consciousness, abuse of antibiotics, indwelling catheter, indwelling gastric tube and mechanical ventilation, in which the age, hospitalization time, disturbance of consciousness, abuse of antibacterial drugs and mechanical ventilation were the most influencial factors.Conclusion The main pathogen of nosocomial infection in patients with cardiogenic cerebral embolism caused by atrial fibrillation was gram-negative bacteria, and the respiratory tract infections were the main tract that caused infection.In addition, the occurrence of infection may be related to age, length of stay, awareness, abuse of antibiotics and mechanical ventilation.