摘要 目的分析医院重症监护室(ICU)患者医院感染病原菌及其影响因素,并总结其防治对策。方法采用回顾性调查法调查2014-2018年安徽医科大学第一附属医院ICU患者的病历资料,统计医院感染及其病原菌情况,收集所有医院感染患者临床资料,归纳ICU患者医院感染的影响因素,总结防治措施。结果共调查2 980例ICU患者,发生医院感染147例,感染率为4.93%;2014-2016年医院感染率分别为5.69%、4.97%、4.84%,呈降低趋势,2017年(5.60%)有上升,2018年有所降低(4.01%);感染部位以下呼吸道(61.22%)、泌尿系统(12.24%)、血管(8.84%)为主;医院感染病原菌以革兰阴性菌(69.87%)为主,位列前三致病菌分别为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;其次为革兰阳性菌(18.91%),以金黄色葡萄球菌检出率(11.54%)最高;真菌(11.22%)中以白假丝酵母检出率(4.49%)最高;年龄、基础疾病、住院时间、泌尿系统插管、使用呼吸机、气管插管、气管切开是ICU患者医院感染的影响因素(P<0.05)。结论 2014-2018年ICU医院感染率整体呈降低趋势,医院感染病原菌以革兰阴性菌感染为主,高龄、合并多种基础疾病、住院时间延长及介入诊疗均为ICU患者发生医院感染的影响因素。为降低ICU医院感染率,应尽可能减少非必要介入性诊疗操作,避免滥用抗菌药物,严格参照药敏试验结果选择敏感性抗菌药物,对高危人群重点监测,对介入性诊疗病例强化感染监测。 OBJECTIVE To analyze the pathogenic bacteria and their influencing factors of nosocomial infections patients in intensive care unit(ICU), and summarize the prevention and treatment strategies.METHODS A retrospectively investigation method was used to analyze the medical records of ICU patients admitted to the First Affiliated Hospital of Anhui Medical University from 2014 to 2018, the status of nosocomial infections and pathogenic bacteria were statistically analyzed. The clinical data of all patients with nosocomial infections were collected, the influencing factors of nosocomial infections were summarized, and prevention and treatment measures were summarized. RESULTS A total of 2 980 ICU patients were investigated, of which 147 cases had nosocomial infections, and the infection rate was 4.93%. The nosocomial infection rates from 2014 to 2016 were 5.69%, 4.97% and 4.84%, respectively, showing a decreasing trend. There was an increase in 2017(5.60%) and a decrease in 2018(4.01%). The top three sites of infections were the lower respiratory tract(61.22%), urinary system(12.24%) and blood vessels(8.84%). Gram-negative bacteria were the main pathogenic bacteria(69.87%), and the top three were Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae;followed by Gram-positive bacteria(18.91%), and the detection rate of Staphylococcus aureus was the highest(11.54%). The detection rate of Candida albicans(4.4%) was the highest in fungi(11.22%). Age, basic diseases, length of hospital stay, urinary system intubation, use of ventilator, tracheal intubation and tracheotomy were the influencing factors of nosocomial infections in ICU patients(P<0.05). ConCLUSION From 2014 to 2018, the overall nosocomial infection rates in ICU showed a decreasing trend, and Gram-negative bacteria were the main pathogenic bacteria. Advanced age, complicated with multiple basic diseases, prolonged hospital stay and interventional diagnosis and treatment were all influencing factors of hospital infections in ICU patients. In
出处 《中华医院感染学杂志》 CAS CSCD 北大核心 2021年第3期472-476,共5页 Chinese Journal of Nosocomiology
基金 国家自然科学基金资助项目(81673242)。
关键词 重症监护室 医院感染 现状 病原菌 影响因素 Intensive care unit Hospital infection Status quo Pathogenic bacteria Influencing factor
