支气管哮喘患儿医院感染病原学特点及影响因素分析
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摘要
目的分析支气管哮喘患儿医院感染的病原学分布特点及相关影响因素。方法选择118例支气管哮喘患儿作为研究对象,利用一次性吸痰管采集患儿呼吸道分泌物,对病原学进行检测分析。记录患儿年龄、性别等一般情况及相关临床化验结果,对以上相关因素分别给予单因素和多因素Logistics分析。结果 118例支气管哮喘住院治疗的患儿共有27例发生医院感染,感染率为22.88%;检出病原菌42株,其中革兰阴性菌69.05%,革兰阳性菌23.81%,真菌7.14%;病毒47株,其中合胞病毒感染31.91%,流感病毒A和流感病毒B,分别占19.15%和12.77%;患儿合并侵入性操作、抗菌药物使用情况不合理及住院时间是导致支气管哮喘患儿医院感染的独立危险因素(P<0.05)。结论支气管哮喘医院感染的患儿,治疗上要依据病原菌分布特点合理使用抗菌药物,同时针对导致其发生医院感染的相关影响因素提出预防对策及合理的护理措施,对于降低支气管哮喘患儿医院感染的发生率和改善患儿预后有着重要意义。
OBJECTIVE To investigate the etiological characteristics and influencing factors for nosocomial infection in children with bronchial asthma so as to put forward the prevention measures. METHODS A total of 118 children with bronchial asthma were recruited as study objects, the respiratory tract secretions were collected from the children by using disposable suction tube. The baseline data such as age and gender as well as results of clinical laboratory examinations were recorded, and univariate analysis and multivariate logistic analysis were performed for the above factors. RESULTS Of the 118 children with bronchial asthma who were hospitalized for treatment, 27 had nosocomial infection, with the infection rate 22.88%. Totally 42 strains of pathogens were isolated, 69.05% of which were gram-negative bacteria, 23.81% were gram-positive bacteria, and 7.14% were fungi. There were 47 strains of viruses, the children with syncytial virus infection accounted for 31.91%, the children with influenza virus A infection accounted for 19.15%, and the children with influenza virus B infection accounted for 12.77%. Invasive procedures, unreasonable use of antibiotics and length of hospital stay were the independent risk factors for the nosocomial infection in the children with bronchial asthma(P<0.05). CONCLUSION It is necessary to reasonable use antibiotics based on the etiological characteristics of the pathogens isolated from the bronchial asthma children with nosocomial infection and put forward the prevention countermeasures and nursing measures according to the influencing factors for the nosocomial infection so as to reduce the incidence of nosocomial infection and improve the prognosis of the children with bronchial asthma.
OBJECTIVE To investigate the etiological characteristics and influencing factors for nosocomial infection in children with bronchial asthma so as to put forward the prevention measures. METHODS A total of 118 children with bronchial asthma were recruited as study objects, the respiratory tract secretions were collected from the children by using disposable suction tube. The baseline data such as age and gender as well as results of clinical laboratory examinations were recorded, and univariate analysis and multivariate logistic analysis were performed for the above factors. RESULTS Of the 118 children with bronchial asthma who were hospitalized for treatment, 27 had nosocomial infection, with the infection rate 22.88%. Totally 42 strains of pathogens were isolated, 69.05% of which were gram-negative bacteria, 23.81% were gram-positive bacteria, and 7.14% were fungi. There were 47 strains of viruses, the children with syncytial virus infection accounted for 31.91%, the children with influenza virus A infection accounted for 19.15%, and the children with influenza virus B infection accounted for 12.77%. Invasive procedures, unreasonable use of antibiotics and length of hospital stay were the independent risk factors for the nosocomial infection in the children with bronchial asthma(P<0.05). CONCLUSION It is necessary to reasonable use antibiotics based on the etiological characteristics of the pathogens isolated from the bronchial asthma children with nosocomial infection and put forward the prevention countermeasures and nursing measures according to the influencing factors for the nosocomial infection so as to reduce the incidence of nosocomial infection and improve the prognosis of the children with bronchial asthma.
引文
[1] 吴彪,庄探月,程东良,等.支气管哮喘合并感染性肺炎患儿对血小板指标、炎性因子水平及 T h1/T h2比值的影响观察[J].中华医院感染学杂志,2016,26(24):5716-5719.
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[11] 李光韬,许玉峰,张卓莉,等.合并支气管扩张的类风湿关节炎患者的临床及影像特点分析[J].中华风湿病学杂志,2016,20(7):465-470.
[12] Pfister H,Morzadec C,Le Cann P.Granulometry,microbial composition and biological activity of dusts collected in French dairyfarms[J].Environ Res,2017,158:691-702.
[13] Gong F,Su Q,Jiang D,et al.High frequency of circulating follicular helper T cells in patients with bronchial asthma[J].Clin Lab,2014,60(6):963-968.
[14] 陶鸿杰,王玮,肖丽娜,等.哮喘患者医院感染病原菌特点及影响因素分析[J].中华医院感染学杂志,2018,28(6):855-858.
[15] Ciolkowski J,Mazurek H,Hydzik P,et al.Inflammatory markers as exacerbation risk factors after asthma therapy switch from inhaled steroids to montelukast[J].Pulm Pharmacol Ther,2016,39:7-13.
[16] Aydogan M,Ozen A,Akkoc T,et al.Risk factors for persistence of asthma in children:10-year follow-up[J].J Asthma,2013,50(9):938-944.
[17] Jesenak M,Banovcin P,Havlicekova Z,et al.Factors influencing the levels of exhaled carbon monoxide in asthmatic children[J].J Asthma,2014,51(9):900-906.
[18] Singh S,Jindal S,Goyal JP.Risk factors for bronchial asthma in school going children[J].Indian J Pediatr,2017,84(11):873-874.
[19] Gaffin JM,Kanchongkittiphon W,Phipatanakul W.Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis[J].Int Immunopharmacol,2014,22(1):21-30.
[20] Ait Bamai Y,Shibata E,Saito I,et al.Exposure to house dust phthalates in relation to asthma and allergies in both children and adults[J].Sci Total Environ,2014,485-486.
[2] Hovland V,Riiser A,Mowinckel P,et al.Asthma with allergic comorbidities in adolescence is associated with bronchial responsiveness and airways inflammation[J].Pediatr Allergy Immunol,2014,25(4):351-359.
[3] 任登华,庄谊,黄永刚.BiPAP治疗重度支气管哮喘急性发作期的临床效果及肺功能、血气指标和炎性因子水平变化情况[J].检验医学与临床,2016,13(23):3311-3313.
[4] 孔菲.糖皮质激素吸入治疗支气管哮喘的临床疗效及其对患者血清蛋白质水平的影响[J].临床合理用药杂志,2017,10(3):19-21.
[5] Thomson NC.Bronchial thermoplasty as a treatment for severe asthma:controversies,progress and uncertainties[J].Expert Rev Respir Med,2018,12(4):269-282.
[6] Nicholas B,Dudley S,Tariq K,et al.Susceptibility to influenza virus infection of bronchial biopsies in asthma[J].J Allergy Clin Immunol,2017,140(1):309-312.e4.
[7] Itagaki T,Aoki Y,Matoba Y,et al.Clinical characteristics of children infected with enterovirus D68 in an outpatient clinic and the association with bronchial asthma[J].Infect Dis (Lond),2018,50(4):303-312.
[8] 中华医学会儿科学分会呼吸学组儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
[9] 吴嘉婴,洪建国.儿童支气管哮喘诊断和防治指南(2016年版)更新要点[J].世界临床药物,2018,39(8):512-517.
[10] 李小鹏,王治国.美国临床实验室标准化委员会标准与指南[J].中华检验医学杂志,2001,24(4):251-252.
[11] 李光韬,许玉峰,张卓莉,等.合并支气管扩张的类风湿关节炎患者的临床及影像特点分析[J].中华风湿病学杂志,2016,20(7):465-470.
[12] Pfister H,Morzadec C,Le Cann P.Granulometry,microbial composition and biological activity of dusts collected in French dairyfarms[J].Environ Res,2017,158:691-702.
[13] Gong F,Su Q,Jiang D,et al.High frequency of circulating follicular helper T cells in patients with bronchial asthma[J].Clin Lab,2014,60(6):963-968.
[14] 陶鸿杰,王玮,肖丽娜,等.哮喘患者医院感染病原菌特点及影响因素分析[J].中华医院感染学杂志,2018,28(6):855-858.
[15] Ciolkowski J,Mazurek H,Hydzik P,et al.Inflammatory markers as exacerbation risk factors after asthma therapy switch from inhaled steroids to montelukast[J].Pulm Pharmacol Ther,2016,39:7-13.
[16] Aydogan M,Ozen A,Akkoc T,et al.Risk factors for persistence of asthma in children:10-year follow-up[J].J Asthma,2013,50(9):938-944.
[17] Jesenak M,Banovcin P,Havlicekova Z,et al.Factors influencing the levels of exhaled carbon monoxide in asthmatic children[J].J Asthma,2014,51(9):900-906.
[18] Singh S,Jindal S,Goyal JP.Risk factors for bronchial asthma in school going children[J].Indian J Pediatr,2017,84(11):873-874.
[19] Gaffin JM,Kanchongkittiphon W,Phipatanakul W.Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis[J].Int Immunopharmacol,2014,22(1):21-30.
[20] Ait Bamai Y,Shibata E,Saito I,et al.Exposure to house dust phthalates in relation to asthma and allergies in both children and adults[J].Sci Total Environ,2014,485-486.