康复医学科病房院内感染病原学分布及相关因素分析

Analysis of bacteriological distribution and correlation factors of nosocomial infection in the rehabilitation department

摘要:

目的：探讨重庆医科大学附属第一医院康复医学科病房院内感染的病原学分布特点及相关因素分析。方法：通过查阅病史及“杏林医院感染实时监控系统”，收集2014年1月至2017年12月期间156名发生院内感染患者及1605名未发生院内感染患者的临床资料，对院内感染的病原菌分布及其影响因素进行回顾性分析。结果：研究期间康复医学科院内感染发生率为8.86%（2014：7.16%；2015：7.73%；2016：10.34%；2017：10.61%）；共检测病原菌235株，检出革兰阴性菌（G-）178株（75.74%），革兰阳性菌（G+）49株（20.85%），真菌8株（3.40%）。G-中最常见的为大肠埃希菌（80株，34.04%），G+中最常见的为金黄色葡萄球菌（18株，7.66%）；5种最常见的院内感染菌株中，多重耐药菌（multi-drug resistant bacteria，MDR）占比最高的为鲍曼不动杆菌（73.91%）；感染部位最常见的为泌尿系统，占55.65%，其次为呼吸系统占20.87%，血液系统感染占8.70%；发生院内感染的疾病最常见的为脑卒中，占36.54%，在发生院内感染的所有病种中以脊髓损伤的院感发生率最高，为63.08%；男性（OR=2.105，95%CI=1.440~3.076，P=0.000）、留置尿管（OR=4.629，95%CI=3.087~6.942，P=0.000）、气管切开（OR=2.427，95%CI=1.293~4.557，P=0.006）以及日常生活活动能力（activity of daily living，ADL）得分＜60分（OR=13.455，95%CI=7.585~23.869，P=0.000）为康复医学科院内感染的危险因素，而留置胃管（OR=0.312，95%CI=0.166~0.587，P=0.000）可能为保护性因素。结论：院内感染的细菌以革兰阴性菌为主，耐药菌比例较高，感染部位以泌尿系感染最常见。发生院内感染最常见的病种为脑卒中，而院感发生率最高的病种为脊髓损伤。男性、留置尿管、气管切开及ADL得分＜60分等可能为院内感染的主要危险因素。

Abstract:

Objective：To examine bacteriological distribution and relative factors of nosocomial infection in the rehabilitation depart－ment of the First Affiliated Hospital of Chongqing Medical University. Methods：The clinical data from 156 patients with and 1 605 patients without nosocomial infection from January 2014 to December 2017 were collected by reviewing the patients’ medical histories and the Xinglin nosocomial infection monitoring system. The bacteriological distribution and relative factors of nosocomial infection were retrospectively analyzed. Results：The nosocomial infection rate in the rehabilitation department during the study period was 8.86%（2014：7.16%；2015：7.73%；2016：10.34%；and 2017：10.61%）. A total of 235 isolates were collected，including 178 gram-negative（G－） bacteria（75.74%），49 gram-positive（G+） bacteria （20.85%），and 8 fungi（3.40%）. The most common G－ pathogen was Escherichia coli（80，34.04%），and the most common G+ pathogen was Staphylococcus aureus（18，7.66%）. Among the 5 most common bacterial strains，Acinetobacter baumannii accounted for the highest proportion of multi-drug resistant bacteria（73.91%）. Urinary infection，respiratory infection，and blood infection accounted for 55.65%，20.87%，and 8.70% of cases，respectively. The main disease with nosocomial infection was stroke，accounting for 36.60% of cases. Patients with spinal cord injury had the highest nosocomial infection rate of 63.08%. Male sex（OR=2.105，95%CI=1.440-3.076，P=0.000），indwelling catheter（OR=4.629，95%CI=3.087-6.942，P=0.000），tracheotomy（OR=2.427，95%CI=1.293-4.557，P=0.006），and activities of daily living（ADL） score of <60（OR=13.455，95%CI=7.585-23.869，P=0.000） were factors that increased susceptibility to nosocomial infection in the department of rehabilitation. Indwelling gastric tube（OR=0.312，95%CI=0.166-0.587，P=0.000） might be a protective factor. Conclusions：The common pathogens were gram-negative bacteria，with a high proportion of multi-drug resistant bacteria. Urinary infections were most common. The main disease with nosocomial infection was stroke，while the patients with spinal cord injury had the highest nosocomial infection rate. Male sex，indwelling catheter，tra－cheotomy，and ADL score of <60 were the risk factors for nosocomial infection.