住院患者发生院内感染的病原学监测及耐药性分析

目的:探讨住院患者院内感染的危险因素、病原学和耐药性,为加强院内感染控制提供依据。方法:回顾性收集2015年1月至2016年7月我院住院患者5665例,根据患者是否发生院内感染将患者分为感染组(n=238)和非感染组(n=5427),分析院内感染患者临床特征、危险因素、病原菌和病原菌的耐药性。结果:共238例患者发生院内感染,培养出病原菌294株。与非感染组比较,感染组患者糖尿病及慢性阻塞性肺疾病发生率显著升高,身体体重指数显著增加,血红蛋白、红细胞显著降低,深静脉置管显著增加,APPACHEⅡ评分≥5分显著增加,住院时间及长期卧床率显著增加(P0.05)。单因素和多因素logistic回归分析显示糖尿病、深静脉置管、住院时间延长和长期卧床是院内感染的危险因素(P0.05)。院内感染以革兰阴性菌较为常见,占62.93%。最常见的革兰阴性菌为铜绿假单胞菌,占13.61%。最常见的革兰阳性菌为金黄色葡萄球菌,占4.08%。金黄色葡萄球菌对氨苄西林、链霉素和青霉素耐药率均为100%,表皮葡萄球菌对氨苄西林、链霉素、青霉素和阿莫西林/棒酸耐药率均为100%。铜绿假单胞菌对氯霉素、头孢曲松和亚胺培南耐药率分别为100.00%、70.00%和65.00%。结论:我院院内感染的危险因素是糖尿病、深静脉置管、住院时间延长和长期卧床,以革兰阴性菌常见,耐药率较高。

Analysis of Risk Factors, Pathogens and Drug Resistance of Nosocomial Infection in Hospital

ABSTRACT Objective: To investigate the risk factors, pathogens and drug resistance of nosocomial infection of in-patients, and to provide evidence for strengthening hospital infection controlling. Methods: 5665 patients who were treated in our hospital from July 2015 to July 2016 were divided into the infection group (n=238) and the non-infection group (n=5427). Then the clinical features, risk factors, pathogens and drug resistance of nosocomial infection in the two groups were analyzed. Results: There were 238 cases developed noso- comial infection and 294 strains of pathogenic bacteria were cultured. Compared with the non-infection group, the incidence of diabetes and chronic obstructive pulmonary disease in the infection group were significantly higher, the body weight index increased, the hemoglobin and red blood cells decreased, the numbers of patients with the deep venous catheterization and the APPACHE score more than 5 points are increased, and the time used for hospitalization and bed-ridden were increased(P<0.05). Univariate and multivariate lo- gistic regres- sion analysis showed that the risk factors for hospital infection were diabetes, deep vein catheterization, prolonged hospital stay and long-term bed-ridde (P<0.05). Gram negative bacteria were common in nosocomial infection, accounting for 62.93%. The most common gram-negative bacteria were Pseudomonas aeruginosa, accounting for 13.61%. The most common gram positive bacteria were Staphylococcus aureus, accounting for 4.08% of the total. The drug resistance rate of Staphylococcus aureus were all 100% to ampicillin, streptomycin and penicillin; the drug resistance rate of Staphylococcus epidermidis were all 100% to ampicillin, streptomycin, penicillin and amoxicillin/clavulanic acid; while the drug resistance rate of Pseudomonas aeruginosa were 100%, 70% and 65% to chlorampheni- col, ceftriaxone and imipenem. Conclusion: The risk factors of nosocomial infection in our hospital are diabetes, deep vein catheteriza- tion, prolonged hospital stay and long-term bed-ridden. Gram negative bacteria are common in nosocomial infection with a high drug re- sistance rate.