急性冠脉综合征患者医院感染与影响因素分析
|
摘要
目的探讨急性冠脉综合征患者医院感染情况及影响因素分析。方法选择2012年1月-2017年6月于医院诊断及治疗的急性冠脉综合征患者818例为研究对象。观察患者医院感染发生情况,感染部位分布及病原学特点。单因素及多因素Logistisc回归分析患者发生医院感染的影响因素。结果 818例急性冠脉综合征患者中共92例发生感染,感染率为11.25%。其中呼吸系统感染53例占57.6%,其次为泌尿系统感染31例占33.7%;92例患者共分离出109株病原菌。革兰阴性菌65株占59.63%,其中以鲍氏不动杆菌和大肠埃希菌为主,分别占23.85%和21.10%;革兰阳性菌42株占38.53%,其中金黄色葡萄球菌30株占27.52%,真菌2株占1.83%;单因素分析结果显示:年龄≥60岁,合并高血压、糖尿病、慢性阻塞性肺疾病、心功能3～4级、急性心肌梗死、合并心力衰竭、心律失常、侵入性操作患者医院感染率较高(P<0.05);多因素分析结果显示:年龄≥60岁、心功能3-4级,急性心肌梗死,合并心力衰竭,侵入性操作,多壁梗死是急性冠脉综合征患者医院感染的独立影响因素(P<0.05)。结论急性冠脉综合征患者因病情重,容易发生医院感染,而高龄、心功能差,急性心肌梗死,尤其是多壁梗死,合并心衰,有侵入性操作是患者医院感染的独立影响因素。
OBJECTIVE To explore the prevalence of nosocomial infection in patients with acute coronary syndrome and analyze the influencing factors.METHODS A total of 818 patients who were diagnosed with acute coronary syndrome and treated in the hospital from Jan 2012 to Jun 2017 were recruited as the study objects.The incidence of nosocomial infection,infection sites and etiological characteristics were observed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection.RESULTS Of the 818 patients with acute coronary syndrome,92 had infection,with the infection rate 11.25%,53(57.6%)of whom had respiratory system infection,and 31(33.7%)had urinary system infection.Totally 109 strains of pathogens were isolated from the 92 patients,65(59.6%)of which were gram-negative bacteria,42(38.53%)were gram-positive bacteria,and 2(1.83%)were fungi;Acinetobacter baumannii and Escherichia coli were the predominant species of the gram-negative bacteria,accounting for 23.85% and 21.10%,respectively;there were 30(27.52%)strains of Staphylococcus aureus among the gram-positive bacteria.The result of the univariate analysis indicated that the incidence of nosocomial infection was high in the patients with no less than 60 years of age,hypertension,diabetes mellitus,chronic obstructive pulmonary disease,grade 3-4 cardiac function,acute myocardial infarction,heart failure,arrhythmia and invasive procedures(P<0.05).The result of the multivariate analysis showed that the no less than 60 years of age,grade 3-4 cardiac function,acute myocardial infarction,heart failure,invasive procedures and multi-wall infarction were the independent influencing factors for the nosocomial infection in the patients with acute coronary syndrome(P<0.05).CONCLUSIONThe patients with acute coronary syndrome tend to have nosocomial infection due to their severe condition;the advanced age,poor cardiac function,acute myocardial infarction,multi-wall infarction,heart failure and invasive procedures are the independent influencing factors for the nosocomial infection.
OBJECTIVE To explore the prevalence of nosocomial infection in patients with acute coronary syndrome and analyze the influencing factors.METHODS A total of 818 patients who were diagnosed with acute coronary syndrome and treated in the hospital from Jan 2012 to Jun 2017 were recruited as the study objects.The incidence of nosocomial infection,infection sites and etiological characteristics were observed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection.RESULTS Of the 818 patients with acute coronary syndrome,92 had infection,with the infection rate 11.25%,53(57.6%)of whom had respiratory system infection,and 31(33.7%)had urinary system infection.Totally 109 strains of pathogens were isolated from the 92 patients,65(59.6%)of which were gram-negative bacteria,42(38.53%)were gram-positive bacteria,and 2(1.83%)were fungi;Acinetobacter baumannii and Escherichia coli were the predominant species of the gram-negative bacteria,accounting for 23.85% and 21.10%,respectively;there were 30(27.52%)strains of Staphylococcus aureus among the gram-positive bacteria.The result of the univariate analysis indicated that the incidence of nosocomial infection was high in the patients with no less than 60 years of age,hypertension,diabetes mellitus,chronic obstructive pulmonary disease,grade 3-4 cardiac function,acute myocardial infarction,heart failure,arrhythmia and invasive procedures(P<0.05).The result of the multivariate analysis showed that the no less than 60 years of age,grade 3-4 cardiac function,acute myocardial infarction,heart failure,invasive procedures and multi-wall infarction were the independent influencing factors for the nosocomial infection in the patients with acute coronary syndrome(P<0.05).CONCLUSIONThe patients with acute coronary syndrome tend to have nosocomial infection due to their severe condition;the advanced age,poor cardiac function,acute myocardial infarction,multi-wall infarction,heart failure and invasive procedures are the independent influencing factors for the nosocomial infection.
引文
[1]初瑞雪,刘信成,孟卫东,等.某三甲医院6637株医院感染病原菌分布及耐药性分析[J].中国现代医生,2018,56(12):116-119.
[2]许建江,张斌,赵圣刚,等.心内科住院患者医院感染的病原菌分布及药敏分析[J].浙江医学,2017,39(22):1998-2001,2004.
[3]毕惠珍,刘润霞,朱道华,等.急性冠脉综合征患者医院感染的相关高危因素分析[J].中华医院感染学杂志,2015,25(1):145-147.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]常方圆,孙泽刚,郝恩刚,等.非ST段抬高性急性冠脉综合征患者并发肺部感染的危险因素分析[J].中华医院感染学杂志,2017,27(20):4675-4677,4692.
[6]胡松,刘翔.非ST段抬高性急性冠脉综合征并发肺部感染的危险因素分析[J].2016,18(6):868-870.
[7] Buttigieg J,Borg C,Rogers M,et al.Seasonal variation in the peritoneal dialysis-related infections:a single center experience in the Mediterranean[J].Ther Apher Dial,2016,20(5):501-506.
[8]李燕,李玉东,李纲.心功能不全合并肺部感染患者的临床分析[J].中华医院感染学杂志,2014,24(1):122-124.
[9]马国平,刘彦双,王蓓,等.心功能不全合并下呼吸道感染患者病原菌分布与耐药性分析[J].中国微生态学杂志,2015,27(3):345-347.
[10]孟庆兰,曾慧,李莉,等.新生儿重症监护病房真菌败血症医院感染暴发调查[J].中华医院感染学杂志,2017,27(8):1849-1851.
[11]刘卫平,海云婷,郭天慧,等.老年患者医院感染现状调查及病原菌耐药分析[J].中华医院感染学杂志,2018,28(11):1645-1649.
[12]许环亲,郭照军,黄茂芹,等.感染性心内膜炎患者医院感染的病原学及相关因素探究[J].中华医院感染学杂志,2018,28(2):199-202.
[2]许建江,张斌,赵圣刚,等.心内科住院患者医院感染的病原菌分布及药敏分析[J].浙江医学,2017,39(22):1998-2001,2004.
[3]毕惠珍,刘润霞,朱道华,等.急性冠脉综合征患者医院感染的相关高危因素分析[J].中华医院感染学杂志,2015,25(1):145-147.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]常方圆,孙泽刚,郝恩刚,等.非ST段抬高性急性冠脉综合征患者并发肺部感染的危险因素分析[J].中华医院感染学杂志,2017,27(20):4675-4677,4692.
[6]胡松,刘翔.非ST段抬高性急性冠脉综合征并发肺部感染的危险因素分析[J].2016,18(6):868-870.
[7] Buttigieg J,Borg C,Rogers M,et al.Seasonal variation in the peritoneal dialysis-related infections:a single center experience in the Mediterranean[J].Ther Apher Dial,2016,20(5):501-506.
[8]李燕,李玉东,李纲.心功能不全合并肺部感染患者的临床分析[J].中华医院感染学杂志,2014,24(1):122-124.
[9]马国平,刘彦双,王蓓,等.心功能不全合并下呼吸道感染患者病原菌分布与耐药性分析[J].中国微生态学杂志,2015,27(3):345-347.
[10]孟庆兰,曾慧,李莉,等.新生儿重症监护病房真菌败血症医院感染暴发调查[J].中华医院感染学杂志,2017,27(8):1849-1851.
[11]刘卫平,海云婷,郭天慧,等.老年患者医院感染现状调查及病原菌耐药分析[J].中华医院感染学杂志,2018,28(11):1645-1649.
[12]许环亲,郭照军,黄茂芹,等.感染性心内膜炎患者医院感染的病原学及相关因素探究[J].中华医院感染学杂志,2018,28(2):199-202.