老年高血压合并糖尿病患者医院感染的临床特点及影响因素分析
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摘要
目的总结老年高血压合并糖尿病患者发生医院感染的部位分布及病原学特点,研究其影响因素,以期降低患者的医院感染率。方法回顾性分析2016年4月-2017年10月医院收住入院的240例患高血压及糖尿病患者的病例资料,通过单因素及多因素对患者医院感染影响因素进行分析,通过对感染部位标本的培养及鉴定,探讨感染的病原菌种类及比例。结果 240例患者发生医院感染33例,感染率13.75%;感染部位主要为呼吸系统和泌尿生殖道为主,分别占39.39%和24.24%;对33例医院感染患者的标本分别进行标准化培养并鉴定,有49例培养基上出现病原菌菌株,包括革兰阴性菌29株,革兰阳性菌16株,真菌4株,分别占比59.18%、32.65%及8.16%;单因素及多因素分析显示老年高血压合并糖尿病患者发生医院感染的独立影响因素是患者住院时间≥7d、病程≥8年、空腹血糖≥10mmol/L、侵入性操作(P<0.05)。结论老年高血压合并糖尿病患者发生医院内感染与多种影响因素有关,临床应针对上述高危因素采取对应的预防措施。
OBJECTIVE To summarize the site distribution of nosocomial infection in senile patients with hypertension and diabetes mellitus and its etiological characteristics,and to study the influencing factors so as to reduce the incidence of nosocomial infection.METHODS The clinical data of 240 patients with hypertension and diabetes mellitus admitted to hospital from Apr.2016 to Oct.2017 were retrospectively analyzed.The influencing factors of nosocomial infection were analyzed by univariate and multivariate analyses.The species and composition of pathogens in the specimens of infected sites were studied by culture and identification.RESULTS There were 33 cases of nosocomial infection(13.75%)in the 240 patients.The infection sites were dominated by respiratory system and genitourinary tract,accounting for 39.39% and 24.24%,respectively.The specimens of the 33 patients with nosocomial infection were subjected to standardized cultivation and identification.A total of 49 strains of pathogens were isolated,including 29 strains of gram-negative bacteria accounting for 59.18%,16 strains of gram-positive bacteria accounting for 32.65%,and 4 strains of fungi accounting for 8.16%.Univariate and multivariate analyses showed that the independent influencing factors of nosocomial infection in elderly patients with hypertension and diabetes were hospitalization time≥7 days,course of disease≥8 years,fasting blood glucose≥10 mmol/L,and invasive operation(P<0.05).CONCLUSION There are multiple influencing factors for nosocomial infection in senile patients with hypertension and diabetes mellitus.Corresponding preventive countermeasures should be taken in clinic according to the risk factors.
OBJECTIVE To summarize the site distribution of nosocomial infection in senile patients with hypertension and diabetes mellitus and its etiological characteristics,and to study the influencing factors so as to reduce the incidence of nosocomial infection.METHODS The clinical data of 240 patients with hypertension and diabetes mellitus admitted to hospital from Apr.2016 to Oct.2017 were retrospectively analyzed.The influencing factors of nosocomial infection were analyzed by univariate and multivariate analyses.The species and composition of pathogens in the specimens of infected sites were studied by culture and identification.RESULTS There were 33 cases of nosocomial infection(13.75%)in the 240 patients.The infection sites were dominated by respiratory system and genitourinary tract,accounting for 39.39% and 24.24%,respectively.The specimens of the 33 patients with nosocomial infection were subjected to standardized cultivation and identification.A total of 49 strains of pathogens were isolated,including 29 strains of gram-negative bacteria accounting for 59.18%,16 strains of gram-positive bacteria accounting for 32.65%,and 4 strains of fungi accounting for 8.16%.Univariate and multivariate analyses showed that the independent influencing factors of nosocomial infection in elderly patients with hypertension and diabetes were hospitalization time≥7 days,course of disease≥8 years,fasting blood glucose≥10 mmol/L,and invasive operation(P<0.05).CONCLUSION There are multiple influencing factors for nosocomial infection in senile patients with hypertension and diabetes mellitus.Corresponding preventive countermeasures should be taken in clinic according to the risk factors.
引文
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[2]吴晓霞,左阿芳,吴建义,等.老年糖尿病患者医院感染的临床特点及影响因素分析[J].中华医院感染学杂志,2017,27(22):5122-5125.
[3]Davids D,Gibson D,Johnson Q.Ethnobotanical survey of medicinal plants used to manage high blood pressure and type2diabetes mellitus in Bitterfontein,Western Cape Province,South Africa[J].J Ethnopharmacol,2016,194:755-766.
[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]刘力生.中国高血压防治指南2010[J].中国医学前沿杂志(电子版),2011,3(5):42-93.
[6]中华人民共和国卫生部医政司.全国临床检验操作规程[M].东南大学出版社,1991.
[7]Bobrow K,Farmer A J,Springer D,et al.Mobile phone text messages to support treatment adherence in adults with high blood pressure(SMS-Text Adherence Support[StAR]):a single-blind,randomized trial[J].Circulation,2016,133(6):592-600.
[8]林丽君,姚勇利,范培云,等.糖尿病患者医院感染病原菌分布与影响因素分析[J].中华医院感染学杂志,2017,27(20):4649-4652.
[9]Iwamuro M,Kondo E,Tanaka T,et al.Endoscopic manifestations and clinical characteristics of cytomegalovirus infection in the upper gastrointestinal tract.[J].Acta Med Okayama,2017,71(2):97-104.
[10]Gunderson CG,Holleck J,Chang JJ,et al.Clinical characteristics and outcomes of veterans hospitalised with purulent soft tissue infections with and without systemic signs of infection[J].Infect Dis(Lond),2016,48(7):503-508.
[11]Requia WJ,Adams MD,Koutrakis P.Association of PM2.5with diabetes,asthma,and high blood pressure incidence in Canada:a spatiotemporal analysis of the impacts of the energy generation and fuel sales[J].Sci Total Environ,2017,584-585:1077-1080.
[12]Lin CY,Tsai FC,Chen YC,et al.Correlation of preoperative renal insufficiency with mortality and morbidity after aortic valve replacement:apropensity score matching analysis:[J].Medicine,2016,95(9):e2576.
[13]乌仁陶古斯,邹良茹.高血压合并糖尿病患者左室舒张功能减退的治疗分析[J].转化医学电子杂志,2016,3(5):43-43,46.
[14]Maia-Leite LH,Catez E,Boyd A,et al.Aortic stiffness aging is influenced by past profound immunodeficiency in HIV-infected individuals:results from the EVAS-HIV(EValuation of aortic stiffness in HIV-infected individuals)[J].J Hypertens,2016,34(7):1338-1346.