Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.

Development of a questionnaire assessing nursing staff’s knowledge,attitude,and practice on the prevention of the nosocomial infection in elderly patients:testing reliability and validity

Objective:To develop a questionnaire assessing nursing staff’s knowledge,attitude,and practice on the prevention of the nosocomial infection in elderly patients and test its reliability and validity.Methods:After the drafted questionnaire was developed,two rounds of Delphi survey were conducted by consulting experts to improve the questionnaire.Subsequently,700 copies of the questionnaire were distributed to nursing staff to assess its reliability and validity.Results:Exploratory factor analysis(EFA)identifies 3 aspects,namely knowledge,attitude,and practice,with a total of 38 items.The Cronbach’s a coefficients of the questionnaire and each of the aspects are 0.85,0.80,0.886,and 0.77(>0.7),respectively.Confirmatory factor analysis(CFA)of each of the aspects are c2/df=3.99,2.26,and 3.32;Goodness-of-fit index(GFI)=0.91,0.97,and 0.92;Root mean square error of approximation(RMSEA)=0.06,0.04,and 0.05;Comparative fit index(CFI)=0.91,0.96,and 0.90.Conclusions:Through this study,it can be ascertained whether the developed questionnaire enjoys sound reliability and validity in assessing nursing staff’s knowledge,attitude,and practice on preventing the nosocomial infection in elderly patients and thus has certain application value.

Clinical analysis of nosocomial infection in 180 elderly patients with hip fractures

Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck

Establishment of a Predictive Diagnostic Model for Acute Mycoplasma Pneumoniae Infection in Elderly Patients with Community-acquired Pneumonia

We established a diagnostic model to predict acute Mycoplasma pneumoniae （M. pneumonia） infection in elderly Community-acquired pneumonia （CAP） patients. We divided 456 patients into acute and non-acute M. pneumoniae infection groups. Binary logistic regression and receiver operating characteristic （ROC） curves were used to establish a predictive model. The following independent factors were identified： age 〉 70 years; serum cTNT level 〉 0.0S ng/mL; lobar consolidation; mediastinal lymphadenopathy; and antibody titer in the acute phase 〉 1：40. The area under the ROC curve of the model was 0.923 and a score of 2 7 score predicted acute M. pneumoniae infection in elderly patients with CAP. The predictive model developed in this study has high diagnostic accuracy for the identification of elderly acute M. pneumoniae infection.

Analysis on Risk Factors of Nosocomial Infection in Orthopedic Patients and Research on Nursing Strategies

Orthopedic patients mostly comprise traumatic patients and elderly or sick individuals. More patients with emergency surgery suffer from open wounds and serious pollution, and operation time is relatively long. Thus, orthopedic patients with surgical incision infection account for a large proportion of incidence of hospital infection. Orthopedic patients are also bedridden for long periods, and they receive poor bone tissue blood supply. In surgical incision infections, mild cases suffer from delayed wound healing, whereas severe cases can form osteomyelitis. This study reviews progress of research on risk factors of nosocomial infection among orthopedic patients in recent years.

Risk Factors for Surgical Site Infections in Patients Operated at the University Clinic of Traumatology-Orthopedics and Restorative Surgery of the National Hospital and University Center Hubert Koutoukou Maga in Cotonou

Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.

Factors Analysis Related towards Behavior of Nosocomial Infection Control on Family Waiting Patient

World Health Organization(WHO)predicted 1.4 million people infected Health Associated Infection(HAIs).One of the risk factors caused is behavior of nosocomial infection control on patient watcher.The purpose is to know relation behavior of nosocomial infection control on patient watcher patient in Semarang hospital and the number of participants was 61 people.Research method was observation with cross sectional approach.Sampling technique was purposive sampling.Data analysis used univariate and bivariate analysis with Pearson correlation test and chi-square test.Result showed a half of them,mean age of the participants was 45.56.Minimum-maximum values were 20-62 with standard deviation 11.114,gender in the research,most of them was female(83.6%),last education was junior high school(34,4%),most of them worked as maids(45.9%).Category of behavior of nosocomial infection control:less(44.3%),moderate(34.4%),and good(21.3%).There is a meaningful relation between behavior of nosocomial infection control behavior with age(p=0.000),education(p=0.000),and occupation(p=0.000).There is no meaningful relation between behavior of nosocomial infection control with gender(p=0.186).Conclusion:there is a meaningful relation between behavior of nosocomial infection control on patient watcher with age,education,and job,while gender does not have a meaningful relation with behavior of nosocomial infection control.Based on this research,it is recommended to be done as intervention which is able to increase behavior of nosocomial infection control on patient watcher by improving nursing service.

Can the detection of IgA anti-Mycoplasma pneumoniae added to IgM increase diagnostic accuracy in patients with infections of the lower respiratory airways?

AIM To evaluate the increase in diagnostic yield, by using IgA in addition to IgM, instead of IgM alone, in relation to the age of the patients.METHODS The study considered 1067 blood samples from patients with clinical signs of lower respiratory tract infections, tested for anti-Mycoplasma IgG, IgM and IgA antibody.RESULTS The increase in diagnostic yield with IgA, compared to IgM detection alone was of 3.5% with statistically significant differences between age groups(0.8% for those equal/under 50 years of age and 4.3% for those over 50).CONCLUSION Our findings demonstrate that IgA detection lead to a twofold increase in the number of diagnoses among the older age groups, but it did not result in relevant increase among the younger age groups.

Surveillance of multidrug resistant uropathogenic bacteria in hospitalized patients in Indian

Objective:To record surveillance,antibiotic resistance of uropathogens of hospitalized patients over a period of 18 months.Methods:Urine samples from wards and cabins were used for isolating urinary tract infection(UTI)-causing bacteria that were cultured on suitable selective media and identified by biochemical tests;and their antibiograms were ascertained by Kirby-Bauer's disc diffusion method,in each 6-month interval of the study period,using 18 antibiotics of five different classes.Results:From wards and cabins,1 245 samples were collected,from which 996 strains of bacteria belonging to 11 species were isolated,during April 2011 to September2012.Two Gram-positive,Staphylococcus aureus(S.aureus)and Enterococcus faecalis(E.faecalis),and nine Gram-negative bacteria,Acinetobacter baumannii,Citrobactcr sp.,Escherichia coli,Enterobacter aerogenes,Klebsiella pneumoniae.Klebsiella oxytoca,Proteus mirabilis,Proteus vulgaris and Pseudomonas aeruginosa were isolated.Both S.aureus and E.faecalis were vancomycin resistant,and resistant-strains of all pathogens increased in each 6-month period of study.Particularly,all Gram-negatives were resistant to nitrofurantoin and co-trimoxazole,the most preferred antibiotics of empiric therapy for UTI.Conclusions:Antibiograms of 11 UTI-causing bacteria recorded in this study indicated moderately higher numbers of strains resistant to each antibiotic studied,generating the fear of precipitating fervent episodes in public health particularly with bacteria,Acinetobacter baumannii,Escherichia coli,Klebsiella pneumoniae and S.aureus.Moreover,vancomycin resistance in strains of S.aureus and E.faecalis is a matter of concern.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

AIM To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis(N-SBP) given the rising importance of multidrug-resistant(MDR) bacteria.METHODS A literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15 th of November 2016, using the following search strategy: "spontaneous" AND "peritonitis".RESULTS The initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies.CONCLUSION N-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

泌尿外科老年住院患者院内感染的风险预测模型构建及效能验证研究

目的 分析泌尿外科老年住院患者院内感染的危险因素,构建泌尿外科老年住院患者院内感染的风险预测模型,并对其效能进行验证。方法 选取成都市第三人民医院泌尿外科2022年1~12月老年住院患者1 050例为研究对象,按照患者医院感染发生情况,分为感染患者(研究组)45例和非感染患者(对照组)1 005例。采用单因素和多因素Logistic法,筛选泌尿外科老年住院患者院内感染的危险因素,进而构建老年住院患者院内感染的风险预测模型。采用Hosmer and Lemeshow进行风险预测模型的拟合优度检验,绘制ROC曲线,评价风险预测模型的预测价值。结果 年龄>75岁、住院时间≥15 d、手术治疗、使用呼吸机辅助通气和留置导尿管是泌尿外科老年住院患者院感发生的危险因素;预测老年住院患者院内感染发生的概率模型:P=1/[1+exp(6.055-0.969X1-2.802X2-1.904X4-1.169X5-2.120X6)];ROC曲线分析显AUC为0.916,95%CI为0.874~0.957。结论 年龄>75岁、住院时间≥15 d、手术治疗、使用呼吸机辅助通气和留置导尿管是泌尿外科老年住院患者院感发生的危险因素,临床实践中应针对上述因素对高危患者人群进行筛查,并实施有针对性的治疗和干预措施以预防感染发生。同时,采用风险预测模型能够对泌尿外科老年住院患者医院感染风险进行科学评价,能够为临床实践提供参考和指导依据。

外科手术患者手术部位感染现状分析及影响因素研究

目的 探讨外科手术患者手术部位感染(SSI)情况及其影响因素。方法 收集2020年1月至2021年12月于安徽省马鞍山市人民医院行外科手术的5 420例患者的临床资料,记录SSI及病原菌。根据患者SSI情况将其分为感染组(46例)与非感染组(5 374例)。比较两组临床资料,通过多因素logistic回归分析确定SSI的影响因素。结果 患者SSI发生率为0.85%(46/5 420)。分离出的48株病原菌中革兰氏阴性菌31株(64.58%),革兰氏阳性菌17株(35.42%)。感染组年龄>65岁、合并糖尿病、全身麻醉、切口类型Ⅲ类、急诊手术、美国麻醉医师协会分级Ⅲ级、术前使用抗菌药物者占比均高于非感染组,手术时间、住院时间均长于非感染组,差异有统计学意义(P<0.05)。影响因素分析显示,年龄(OR=2.125,95%CI:1.104~4.090)、合并糖尿病(OR=2.585,95%CI:1.327~5.036)、手术时机(OR=2.209,95%CI:1.306~3.736)、手术时间(OR=2.704,95%CI:1.325~5.518)、住院时间(OR=2.767,95%CI:1.348~5.680)、切口类型(OR=2.159,95%CI:1.128~4.325)、术前抗菌药物使用情况(OR=0.784,95%CI:0.673~0.995)是外科手术患者SSI的影响因素(P<0.05)。结论 年龄、糖尿病、手术时机、手术时间、住院时间、切口类型、术前抗菌药物使用是外科手术患者SSI的影响因素,针对上述因素予以早期干预有利于减少SSI。

护士为主体的医院感染控制小组对综合病区住院患者医院感染控制的作用

目的:探讨护士为主体的医院感染控制小组对综合病区住院患者医院感染控制的作用。方法:选取2022年6月至2023年6月本院综合病区收治的住院患者420例,根据随机数字表法分组为对照组与研究组,每组210例。对照组实施常规医院感染管理,研究组采用护士为主体的医院感染控制小组。观察两组患者感染控制情况、患者对医院感染知识的掌握情况、感染控制质量评分及患者对医院感染管理的满意度。结果:研究组总感染发生率低于对照组(P<0.05);研究组患者对医院感染知识的掌握度评分、感染控制管理质量评分表各项评分高于对照组(P<0.05);研究组患者对医院感染管理的总满意率高于对照组(P<0.05)。结论:护士为主体的医院感染控制小组可降低综合病区住院患者医院感染发生率,增强患者感染防护意识,且可提高医院感染控制质量及患者对医院感染管理的满意度。

重症监护病房住院患者医院感染调查与管理

重症监护室(intensive care unit,ICU)主要收治的患者多为危重症,住院患者需要接受很多有创治疗,且住院时间较长,这会增加医院感染风险。医院感染的诱发因素非常复杂,考虑与年龄、性别、住院时间、手术部位等因素密切相关。本文旨在对ICU住院患者的感染现状及其影响因素进行分析,并根据具体情况提出行之有效的管理防控对策,以将医院感染风险降至最低。

2019~2021年某肿瘤专科医院院内感染情况分析

【目的】为了解肿瘤医院院感情况及其变化趋势,探讨肿瘤专科医院感染防控重点策略。【方法】通过医院感染监测系统获取中山大学肿瘤防治中心2019~2021年医院感染质量控制指标数据,采用卡方检验和趋势卡方检验对指标变化进行分析。【结果】2019~2021年该院院感发生率分别为0.80%、0.78%和0.57%,逐年显著下降(P<0.001)。其中以手术部位和呼吸系统感染较常见,两部位占比分别是35.75%和31.08%。革兰阴性菌和真菌是主要病原体。多重耐药菌院感发生率逐年显著上升,从0.08‰上升至0.14‰(P<0.001),其中耐甲氧西林金黄色葡萄球菌、碳青霉烯类肠杆菌和产超广谱β-内酰胺酶细菌上升明显。三管相关感染发生率在3年间无显著差异(P>0.05),仍处较高水平。【结论】2019~2021年该肿瘤专科医院院感情况总体得到改善。呼吸系统和手术部位、产超广谱β-内酰胺酶细菌为主的多重耐药菌及三管相关感染防控是肿瘤专科医院医院感染防控工作薄弱环节,应重点推进。

1M3S感控管理模式对骨科患者术后医院感染 发生率的影响

目的研究1M3S感控管理模式对骨科患者术后医院感染发生率的影响。方法回顾性选取2020年1月至2021年8月南昌大学第一附属医院40例骨科术后行常规感控管理的患者作为对照组,回顾性选取2021年9月至2022年5月南昌大学第一附属医院40例骨科术后行1M3S感控管理的患者作为研究组,比较两组患者术后医院感染发生情况、疼痛程度、院感控制质量、住院时间和费用。结果干预后,研究组的医院感染发生率低于对照组,差异有统计学意义(P<0.05);干预后,研究组的疼痛程度轻于对照组,差异有统计学意义(P<0.05);干预后,研究组的院感管理质量优于对照组,差异有统计学意义(P<0.05);干预后,研究组的住院时间短于对照组,研究组的住院费用低于对照组,差异有统计学意义(P<0.05)。结论对骨科患者术后实施1M3S感控管理模式能有效减少患者医院感染发生率,缓解其术后疼痛,减短住院时间,降低住院费用,值得临床推广。

消化内科老年患者医院感染病原菌分布、危险因素分析及对策研究

目的:探讨消化内科老年患者医院感染病原菌分布、危险因素分析及对策研究。方法:选取2019年5月至2022年10月收治的265例消化内科老年患者作为研究对象,根据患者住院期间是否发生感染分为感染组(n=87)与非感染组(n=178),观察消化内科并发医院感染老年患者的感染部位及经菌株分离培养后的病原菌分布情况;采用二元logistic回归模型分析影响消化内科老年患者并发医院感染的危险因素。结果:265例消化内科老年患者发生感染共87例,其中呼吸道感染33例、泌尿系统感染15例、消化系统感染20例、皮肤软组织感染13例、导管相关血流感染6例。87例消化内科并发医院感染老年患者经细菌培养分离出87株病原菌,其中革兰阳性菌共28株(32.18%),革兰阴性菌共52株(59.77%),真菌共7株(8.05%)。感染组与非感染组在性别、病程、高血压史、吸烟史、饮酒史、体质指数等基线资料比较中,差异无统计学意义(P>0.05);而在年龄、抗生素使用时间、住院时间、机械通气、糖尿病、留置导尿管、血红蛋白、白蛋白、留置胃管等基线资料比较中,差异具有统计学意义(P<0.05)。logistic回归分析显示,年龄>70岁、抗生素使用时间>48 h、住院时间>15 d、机械通气、糖尿病、留置导尿管、血红蛋白<90 g/L、白蛋白<30 g/L、留置胃管是影响消化内科老年患者并发医院感染的独立危险因素(P<0.05)。结论:消化内科并发医院感染老年患者病原菌中以金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌占主导位置,且医院感染发生与年龄、抗生素使用时间、住院时间、机械通气、糖尿病、留置导尿管、血红蛋白<90 g/L、白蛋白<30 g/L、留置胃管等因素有关,临床应提高重视,通过予以相关干预措施,降低医院感染发生率。

老年TBI患者医院感染危险因素探讨与预测模型构建

目的:探讨老年颅脑创伤(TBI)患者发生医院感染的危险因素,建立并验证预测模型。方法:纳入南京大学医学院附属鼓楼医院神经外科2019年6月至2022年6月开颅手术治疗的270例老年TBI患者,按8:2比例分为模型组(n=216)和验证组(n=54)。回顾性分析模型组患者在院期间临床资料,单因素及多因素分析医院感染危险因素,构建感染预测模型,并基于验证组数据检验其预测效能。结果:270例患者发生医院感染59例,占比21.85%。模型组单因素分析显示,年龄、TBI严重程度、低蛋白血症、气管切开、机械通气、卧床时间和留置尿管时间与医院感染相关。Logistic多因素回归分析显示,年龄>75岁、重型TBI、气管切开、机械通气、卧床时间>12天和留置尿管时间>7天是老年TBI患者医院感染独立危险因素(P <0.05)。进一步构建感染预测模型:Z=-7.341+1.955×年龄+2.665×TBI严重程度+1.616×气管切开+1.833×机械通气+1.610×卧床时间+1.392×留置尿管时间。模型受试者工作特征曲线下面积为0.938(95%CI0.901~0.974),Hosmer-Lemeshow检验χ^(2)=9.400(P> 0.05)。最大Youden指数为0.740,对应最佳截断值为0.502,敏感度为0.822,特异性为0.941。代入验证组数据显示模型预测准确率为0.944,敏感度为0.833,特异性为0.976。结论:高龄、重型TBI、气管切开、机械通气、长期卧床和长期留置尿管增加老年TBI患者医院感染风险,基于此构建的模型预测效能和拟合度良好,可为潜在感染患者的早期发现和治疗提供依据。

强化院内感染管理在神经内科老年患者医院感染控制中的应用价值

目的探讨强化院内感染管理在神经内科老年患者医院感染控制中的应用价值。方法选取2018年11月至2020年11月中国人民解放军联勤保障部队第九二四医院收治的100例老年患者作为研究对象,按不同管理方法分为强化管理组与对照组,每组50例。对照组给予常规的院内感染管理,强化管理组给予强化院内感染管理。比较两组医院感染发生情况、院区空气卫生、病区物体表面合格率及护理满意度。结果强化管理组总感染率为2.00%,低于对照组的14.00%,差异有统计学意义(P<0.05)。强化管理组院区空气卫生、病区物体表面的合格率均高于对照组,差异有统计学意义(P<0.05)。强化管理组总满意度为98.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。结论强化院内感染管理应用于神经内科老年患者医院感染控制中,可有效降低医院感染发生率,提高卫生合格率及护理满意度,值得临床推广应用。

“绿色-安全”大感控理念在院内感染管控中的应用效果分析

目的:分析“绿色-安全”大感控理念在院内感染管控中的应用效果。方法:选取本院2019年1月至2021年10月收入的500例患者为研究对象,依据“绿色-安全”大感控理念实施时间段分为两组各250例。对照组实施传统的院内感染管控,观察组则是实施“绿色-安全”大感控理念,对比两组患者的院内感染(伤口/切口感染、肺部感染、泌尿系统感染)总发生率、医疗服务满意度(服务态度、操作水平、沟通能力、服务及时性)评分、护患纠纷(护理管理纠纷、护理技术纠纷、护士职业道德纠纷)总发生率差异。结果:观察组的院内感染总发生率6.00%、护患纠纷总发生率8.00%,低于对照组的15.60%、20.00%,差异有统计学意义(P<0.05);实施前两组患者的医疗服务满意度评分比较,差异无统计学意义(P>0.05),实施后均高于实施前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:在院内感染管控中“绿色-安全”大感控理念有助于降低院内感染总发生率以及护患纠纷总发生率、提升患者的医疗服务满意度评分,值得使用。