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

Analysis of pathogenic bacteria distribution,risk factors and countermeasures of nosocomial infection in elderly patients in gastroenterology department

摘要:

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。

Abstract:

Objective To investigate the distribution of pathogenic bacteria，risk factors and countermeasures of nosocomial infection in elderly patients in gastroenterology department.Methods A total of 265 elderly patients admitted to the Gastroenterology Department，Chongqing Emergency Medical Center from May 2019 to October 2022 were selected as research objects. According to whether the patients had infection during hospitalization，they were divided into the infected group（n=87） and the non-infected group（n=178）. The infected sites of elderly patients with nosocomial infection in the department and the distribution of pathogenic bacteria after isolation and culture were observed. Binary logistic regression model was used to analyze the risk factors of nosocomial infection in elderly patients in the gastroenterology department.Results Among 265 elderly patients in the gastroenterology department，87 cases were infected，including 33 cases of respiratory tract infection，15 cases of urinary tract infection，20 cases of digestive system infection，13 cases of skin and soft tissue infection，and 6 cases of catheter-related bloodstream infection. And 87 strains of pathogenic bacteria were isolated from 87 elderly patients with nosocomial infection in the gastroenterology department by bacterial culture，including 28 strains of Gram-positive bacteria（32.18%），52 strains of Gram-negative bacteria（59.77%） and 7 strains of fungi（8.05%）. There was no significant difference in gender，course of disease，history of hypertension，smoking history，drinking history and BMI between the infected group and the non-infected group（P>0.05）. There were statistically significant differences in age，duration of antibiotic use，length of hospital stay，mechanical ventilation，diabetes，indignant catheter，hemoglobin，albumin，and indignant gastric tube（P<0.05）. Logistic regression analysis showed that age > 70 years old，duration of antibiotic use > 48 h， duration of hospital stay > 15 d，mechanical ventilation，diabetes，indignant catheter，hemoglobin < 90 g/L，albumin< 30 g/L and indignant gastric tube were independent risk factors for nosocomial infection in elderly patients in the gastroenterology department（P<0.05）.Conclusion Staphylococcus aureus，Acinetobacter baumannii and Pseudomonas aeruginosa dominate the pathogenic bacteria in elderly patients with nosocomial infections in the gastroenterology department，and the occurrence of nosocomial infections is related to age，antibiotic use time，hospital stay，mechanical ventilation，diabetes，indignant catheter，hemoglobin < 90 g/L，albumin < 30 g/L，indignant gastric tube and other factors. Clinical attention should be paid to reducing the incidence of nosocomial infection through relevant intervention measures.