273例肿瘤患者医院感染情况分析

1999～2003年,我院收治的2434例肿瘤患者中发生医院感染273例(303次)。现将感染相关因素分析报告如下。     

海南某医院住院患者医院感染特点及危险因素分析

目的 通过调查住院患者医院感染特点及相关危险因素,为科学干预医院感染发生提供参考。方法 采用回顾性分析法调查我院2018年全年94 635例住院患者的临床资料,了解医院感染的特点,同时采用单因素分析和多因素logistic回归分析研究发生医院感染的危险因素。结果 发生医院感染2211例,感染率为2.34%,以下呼吸道感染为主;2531例医院感染中共培养出病原菌1004株,以革兰阴性菌为主;患者年龄、住院天数、呼吸机使用和合并肿瘤是该院发生医院感染的独立危险因素（P <0.05）。结论 我院2018年医院感染发生率控制良好,通过对医院感染的高危因素进行了深入研究得出住院时长> 31 d、使用呼吸机的住院患者发生医院感染风险较高。由于医院感染的发生涉及的因素与环节众多,临床上应针对危险因素采取科学有效的干预及防控措施,减少医院感染的发生。     

神经外科患者142例医院感染调查分析

目的调查分析神经外科住院患者医院感染情况,探讨其危险因素及感染的特点,为预防及控制感染提供依据。方法采用回顾性分析的方法,查阅于2012-01~2013-12共1 283例神经外科住院患者发生医院感染的情况进行调查分析。结果发生医院感染的有142例次,例次感染发生率为11.1%。感染部位以下呼吸道为主,其次是泌尿道。感染的病原菌中革兰阴性菌为首位,占78.2%,革兰阳性菌占16.4%,真菌占5.4%,分布前4种病原菌分别为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌及金黄色葡萄球菌。医院感染的发生与患者的年龄、住院天数、昏迷程度、免疫功能低下及各种侵入性操作等危险因素有关(P0.05)。结论神经外科是医院感染的高发科室,应针对各种危险因素采取相应的预防措施,同时加强医院感染的管理及防控意识,可有效的减少神经外科医院感染的发生。     

老年糖尿病患者发生医院感染的调查分析

目的 探讨老年糖尿病患者医院感染的危险因素.方法 对2009-01～2011-01住院的老年糖尿病患者医院感染情况及其危险因素进行回顾性分析.结果 153例老年糖尿病患者中有32例发生医院感染,感染率为20.92%,感染部位以上呼吸道及肺部最多见,占37.5%,其次为泌尿道28.13%,主要危险因素有高龄(≥60岁)、住院周期长、血糖值过高、糖尿病并发症以及大量使用广谱抗菌药物等.结论 老年糖尿病患者发生医院感染率高于一般疾病的医院感染率,应加强防治.     

糖尿病患者医院感染状况与相关因素分析

对 12 8 3例糖尿病 (DM)患者医院感染回顾性调查表明 ,DM医院感染率为 9.68%～ 11.2 5 % ,均高于同期全院医院感染率。且随着DM住院人数逐年增多 ,DM医院感染群体不断增大。统计分析显示 :DM代谢控制不良、急慢性并发症、住院天数长、滥用抗生素、侵袭性诊疗措施等为DM医院感染的危险因素。积极治疗原发病、合理应用抗生素、避免侵袭性诊疗措施是防治DM医院感染的关键。     

老年患者医院内感染的调查分析

老年人是医院感染的易感人群。本文对我科老年人医院感染 12 1例进行回顾性调查分析。1　临床资料全部病例为 2 0 0 0年 1月～ 2 0 0 3年 12月期间入住我科的老年患者 ,共 815例 ,发生院内感染 12 1例 ,感染 196例次 ,其中男 117例 ,女 4例 ,年龄 64～ 95岁 ,平均年龄 (75 5± 15 5 4)岁 ,住院时间 18～ 498d ,平均 110d。医院感染诊断符合卫生部“医院感染诊断标准” ,感染患者基础疾病按入院诊断统计 ,不能定位的肿瘤均归于“肿瘤”类。细菌鉴定以《全国临床检验》(第 2版 )为依据。本调查的病历按统一表格统一登记。2　结果与讨论2 1…     

恶性肿瘤患者医院感染危险因素分析及防控措施

目的探讨恶性肿瘤患者医院感染的临床特点与危险因素,为减少医院感染制定有效的防控措施提供理论依据。方法回顾性调查2006年1月～2008年12月我院收治的9429例恶性肿瘤患者的临床资料,对医院感染的各种危险因素进行分析和统计学处理。结果 9429例恶性肿瘤患者中发生医院感染者明显高于非肿瘤患者;感染部位以呼吸道为主,占54.3%;病原菌多为耐药的条件致病菌和真菌,以革兰阴性菌为主,占52.7%,真菌占32.1%;医院感染与年龄、住院时间、疾病分期、营养状态、贫血、低血清白蛋白、白细胞减少、使用激素、使用抗菌药物、侵入性操作、手术、化疗以及是否合并糖尿病等密切相关;发生医院感染者不但延长患者的住院时间,而且还增加患者的病死率。结论恶性肿瘤患者易发生医院感染,感染是多种因素共同作用的结果;控制感染的危险因素,规范抗肿瘤治疗,加强营养支持治疗,提高机体免疫力是防控肿瘤患者医院感染的主要措施。     

老年医院感染患者585例危险因素分析

老年患者免疫功能低下,病原微生物不断变迁,抗菌药物广泛应用,造成细菌耐药性的迅速产生,本文回顾性分析老年住院患者医院感染情况,为其临床防治提供依据。1资料与方法1.1临床资料2010年1月至2011年1月我院≥60岁老年住院患者4 930例,其中585例患者发生医院感染。1.2调查方法采用回顾性调查方法依据患者的临床症状、     

老年患者医院感染的易感因素分析

目的研究老年人易发生医院感染的危险因素,针对性制定预防措施,减少老年住院患者医院感染的发生。方法从糖尿病、恶性肿瘤、老年痴呆、长期卧床、留置鼻胃管、血红蛋白、血清白蛋白水平、住院天数等方面入手,分析比较发生医院感染患者与未发生医院感染老年人之间的差别。结果恶性肿瘤、老年痴呆症及长期卧床的住院老年患者易发生医院感染,住院时间长,血红蛋白及血清白蛋白水平较低也是危险因素,差异有统计学意义(P<0.01)。结论加强对患慢性疾病且长期卧床住院老年病人护理,增强营养支持、改善体质、缩短住院时间,尽量减少医院感染的发生。     

血吸虫病肝纤维化患者医院感染的临床特点及危险因素分析

目的探究血吸虫病肝纤维化患者医院感染的临床特点及危险因素。方法回顾性分析血吸虫病肝纤维化患者病历资料,筛选出发生医院感染者,计算医院感染发生率,并统计不同部位发生感染的情况及其常见病原菌类型,分析每种病原菌的耐药情况。分析性别、年龄、住院时间、有创性操作、抗菌药物使用、营养状况及驱虫药物使用情况与医院感染的相关性。结果 578例患者中发生医院感染的有79例,医院感染发生率为13.66%,下呼吸道和泌尿道感染发生率最多,分别占44.30%、32.91%,主要致病菌主要为大肠杆菌(24.05%)、铜绿假单胞菌(21.52%)、金黄色葡萄球菌(17.72%)。大肠杆菌对头孢曲松、头孢呋辛、左氧氟沙星耐药率较高,对亚胺培南、哌拉西林、头孢哌酮、阿米卡星较敏感;铜绿假单胞菌对头孢呋辛、头孢曲松、氨曲南耐药率较高,对亚胺培南、哌拉西林、头孢哌酮较敏感;金黄色葡萄球菌对头孢呋辛、氨曲南、环丙沙星耐药率较高,对哌拉西林、头孢哌酮、亚胺培南较敏感。不同性别、规律使用驱虫药物与否在医院感染的发生率上无明显差异(P>0.05),年龄大小、住院时间长短、是否有有创性操作、使用抗菌药物种类的多少、营养状况在医院感染的发生率上有显著性差异(P<0.05),Logistic回归分析显示高龄、住院时间过长、有创性操作、抗菌药物种类过多、营养不良是血吸虫病肝纤维化患者发生医院感染的独立危险因素。结论血吸虫病肝纤维化患者发生医院感染的概率较大,部位主要以下呼吸道、泌尿道为主,致病菌主要为G^-菌,且其对一二代头孢类药物普遍耐药。高龄、住院时间过长、有创性操作、抗菌药物种类过多及营养不良是医院感染的独立危险因素,医务人员在临床工作中应重视医院感染,减少有创操作次数,减少导管留置及住院时间,及时给予营养支持,对于合并感染的患者应做到合理使用抗菌药物,减少耐药产生。     

终末期肝病营养代谢特点

<正>终末期肝病(end stage 1iver disease,ESLD)泛指各种慢性肝脏损害所导致的晚期肝病阶段,其主要特征为肝细胞功能不能满足人体的生理需求。在大多数情况下,ESLD大致相当于失代偿期肝硬化及其所致的慢性肝衰竭~([1])。由于终末期肝病患者肝功能严重受损,机体会出现复杂的营养和代谢功能紊乱及不同程度的蛋白质-能量营养不良(protein-energy malnutrition,PEM)。研究发现,大约     

Occult hepatitis B virus infection in patients with autoimmune liver diseases

Background: Occult hepatitis B virus (HBV) infection is characterized by undetectable serum HBV surface antigen (HBsAg) but detectable HBV‐DNA in serum or liver. Aims: To determine the prevalence and clinical impact of occult HBV in autoimmune liver diseases as similar data are missing. Methods: One hundred and ninety‐six sera samples from HBsAg‐negative patients, including 66 autoimmune hepatitis (AIH), 93 primary biliary cirrhosis (PBC) and 37 primary sclerosing cholangitis (PSC), were investigated for HBV‐DNA using the polymerase chain reaction (PCR) before treatment initiation. One hundred and three serial samples from 38 AIH patients under immunosuppression and 282 selected blood donors (HBsAg negative; antibodies to HBV‐core antigen positive) were also investigated. Fourteen available paraffin‐embedded AIH liver samples were also investigated for HBV‐DNA by nested‐PCR. Results: Hepatitis B virus DNA was detected in the serum of 24/196 patients (12.2%) and 0/282 donors (P=0.0000). Nine patients had AIH (13.6%), eight had PBC (8.6%) and seven had PSC (18.9%) (P=0.0000 vs healthy). HBV‐DNA detection in AIH livers was higher than in serum. HBV‐DNA was associated neither with HBV markers nor with epidemiological, laboratory and clinical data. Serial testing of AIH patients revealed two HBV‐DNA‐negative patients before treatment becoming positive during treatment, while all HBV‐DNA‐positive patients before immunosuppression became negative. Conclusion: Based mainly on serum HBV‐DNA, we found a significant proportion of autoimmune liver disease patients with occult HBV compared with donors. However, taking into account our results in a small number of liver tissues, it should be emphasized that occult HBV could be even higher when both serum and liver specimens are investigated. Occult HBV does not seem to affect the clinical and laboratory features of the diseases, while AIH patients with occult HBV under immunosuppression do not deteriorate during follow‐up.     

Clinical significance of Staphylococcus aureus infection in patients with chronic liver diseases

Background: Staphylococcus aureus increasingly is recognized as an important pathogen in patients with chronic liver diseases. The purpose of this study was to evaluate clinical features and the outcome of S. aureus infections in patients with chronic liver diseases. Methods: From the database of a surveillance study for S. aureus infections, the data regarding S. aureus infections in patients with chronic liver diseases were analysed and compared with those in patients with other diseases. Results: We identified 298 patients who had chronic liver diseases; 151 (50.7%) patients had cirrhosis, 76 (25.5%) had chronic hepatitis and the remaining 71 (23.8%) had other diseases. The most common type of S. aureus infection in patients with chronic liver diseases was primary bacteraemia (n=68, 22.8%) and 92 (30.9%) patients had concomitant bacteraemia. When compared with other disease group, bacteraemia and bone infection were more frequent in the liver disease group (P<0.05). The 30‐day mortality rate of the liver disease group was significantly higher than that of the other disease group (29.4 vs. 16.7%, P<0.001). A multivariate analysis showed that chronic liver disease was a significant factor associated with mortality, along with old age, immunosuppressive treatment, intubated state, indwelling urinary catheter, pneumonia and concomitant bacteraemia. Conclusions: Bacteraemia was the most common type of S. aureus infection in patients with underlying liver diseases, predicting higher mortality rates. The mortality rate of patients with liver diseases was significantly higher than that of patients with other diseases when S. aureus infection developed.     

Hepatitis C virus infection in patients with clinically diagnosed alcoholic liver diseases

Summary To determine the incidence of hepatitis C virus (HCV) infection in patients with alcoholic liver disease (AID), serum samples from 252 patients with AID were tested for anti-HCV and HCV RNA. Serial sera of these patients were collected and stored under optimal conditions to allow exact quantification of HCV RNA. Fifteen patients who visited our hospital during the same period of time with chronic HCV infections served as controls. In those with AID, anti-HCV and HCV RNA were positive in 55.5% and 41.2%, respectively. Patients with histologically diagnosed chronic hepatitis and hepatocellular carcinoma had much higher prevalence rates of HCV RNA (84% and 100%, respectively) compared to those with fatty liver (4.3%), hepatic fibrosis (10.1%) and alcoholic hepatitis (22.2%) ( P < 0.01). Although no difference in serum HCV RNA levels was observed between the patients with both AID and chronic HCV infection and those with chronic HCV infection alone, HCV RNA levels significantly (10-fold) dropped after abstinence in nearly half of the patients ( P < 0.01). These data indicate that HCV infection in patients with AID promotes progression of liver disease, and abstinence from alcohol is associated with a reduction in serum HCV RNA levels.     

感染相关性儿童肝病

儿童时期各种嗜肝病毒和其他病毒感染以及各种细菌、真菌等不同病原体感染都可累及肝脏,肝脏病变常为全身感染的一部分,较少引起典型的肝炎症状,也可出现严重的肝损伤。机体免疫状态与临床特征密切相关。急性病毒性肝炎病理多为肝脏全小叶细胞的弥漫性变性,慢性肝炎特征为肝实质与汇管区的炎症与纤维化等。不同细菌、真菌感染可引起肝脏化脓性病变,也可以肉芽肿的病变为主,需要综合全面分析临床资料等确诊。     

Simian TT virus (s-TTV) infection in patients with liver diseases

Recently, we identified TTV isolates from nonhuman primates and named them simian TTV (s-TTV). To investigate the prevalence of s-TTV in humans, we examined sera from healthy individuals and patients with liver diseases in Japan for the presence of s-TTV DNA by PCR assay. s-TTV DNA was determined by nested PCR using s-TTV-specific primers designed from untranslated region of s-TTV genome. s-TTV DNA sequence was detected in three of 200 (1.5%) healthy adults but none of 48 infants without liver disease. On the other hand, s-TTV DNA was detected in 30 of 287 (10.5%) Japanese patients with liver disease. s-TTV coinfection with hepatitis B virus and hepatitis C virus were present in 16.7 and 30% of these patients, respectively, while 53.3% of patients were positive for s-TTV alone. Nucleotide sequence analyses in 20 patients confirmed that these PCR products were derived from s-TTV genome sequences and nearly 85% identical to those of s-TTV prototypes from chimpanzees. Phylogenetic analysis demonstrated that all s-TTV isolates from humans were distinguished clearly from the human TTV isolates. Furthermore, s-TTV in humans was classified into two different genotypes as well as simians. Our results indicate that generally 10.5% of Japanese patients with liver diseases were infected with s-TTV. The routes of s-TTV transmission from animal to human require clarification.     

肝脏疾病并发医院真菌感染507例分析

目的了解肝脏疾病患者院内真菌感染的抗菌药物应用情况,以探讨肝脏疾病患者院内真菌感染与抗生素应用之间的关系。方法应用回顾性调查方法对我院1986年1月至2006年6月发生院内真菌感染的507例肝脏疾病患者临床资料进行分析。结果真菌感染前有446例(87.97%)患者使用抗生素,使用抗菌药物最多的为第3代头孢菌素、氟喹诺酮类、青霉素类。在抗菌药物应用中存在用药起点高、联合用药者多,疗程过长或频繁换药,真菌感染后未及时停药等现象。结论肝脏疾病患者合并真菌感染后加重基础肝病,预后差。不合理使用抗生素与真菌感染密切相关。     

Immunohistochemical detection of HCV infection in patients with hepatocellular carcinoma and other liver diseases

ＩｍｍｕｎｏｈｉｓｔｏｃｈｅｍｉｃａｌｄｅｔｅｃｔｉｏｎｏｆＨＣＶｉｎｆｅｃｔｉｏｎｉｎｐａｔｉｅｎｔｓｗｉｔｈｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａａｎｄｏｔｈｅｒｌｉｖｅｒｄｉｓｅａｓｅｓＺＨＡＮＧＬｉＦａ１,ＰＥＮＧＷｅｎＷｅｉ２,...