病毒性肝炎住院患者医院感染的调查分析

目的探讨传染病科病毒性肝炎患者医院感染现患率及影响因素。方法2003年3月至2004年11月收治各型病毒性肝炎患者595例,男487例,女108例,年龄13~72岁,平均37岁,各型肝炎诊断依据1990年全国第六次病毒性肝炎学术会议(上海)修订的标准,参照郑明新等主编的《医院感染》各部位感染诊断标准判定医院感染情况。结果研究对象中有55例发生医院感染,感染发生率9.2%,感染次数为67例次,感染例次率11.3%;死亡13例,病死率为2.2%,其中未发生医院感染者的病死率为1.5%(8/540),发生医院感染的病死率为9.15%(5/55),死亡患者医院感染发生率为38.5%(5/13),感染例次率为76.9%(10例次/13例)。医院感染部位分布于腹腔(21例)、呼吸系统(18例)、泌尿生殖系统(6例)、口腔(6例)、胃肠道系统和皮肤软组织(各2例)。发生医院感染者中有26例次进行了病原微生物检查,送检率为38.8%,病原学检查阳性的有18例次,阳性率为69.2%。结论肝硬化、重度慢性肝炎患者是医院感染的高发人群,预后差,死亡率高。感染的发生还与患者的病理状态、住院时间、有无创伤性介入检查史以及抗生药物、激素、免疫抑制剂预防或治疗史有关。

A survey on nosocomial infections in patients with viral hepatitis

Objective To investigate the incidence and risk factors of nosocomial infections in patients with viral hepatitis. Methods From march 2003 to November 2004,595 patients with viral hepatitis were investigated. Of all the patients, 487 were men, 108 were women, aged from 13 to 72 years. Diagnosis of hepatitis is according to "the diagnostic standard of viral hepatitis revised in shanghai,1990", and the evaluation of nosocomial infections is according to "Nosocomial infection" (Edited by Zheng MX). Results sixty-seven occasions of nosocomial infections occurred in 55 of 595 patients and the incidence was 9.2%. The infection sites were distributed in abdominal cavity (n=21),respiratory system(n=18),urogenital system (n=6),mouth cavity(n=6),digestive system(n=2),and skin and soft tissue(n=2),respectively. Pathogenic bacteria were examined in 26 cases. And 18 samples were positive with a positive rata of 69.2%. Conclusion The incidence of nosocomial infections in a intectious diseases hospital is similar to the average rate in gerneral hospitals in china. The patients with cirrhosis or severe chronic hepatitis have higher nosocomial infectious probability. They have unfavourable prognosis and higher mortality. The incidence of nosocomial infections is related to patients pathological state, the duration of hospitalization, the aspiration biopsy or/and catherterizations, and utilization of antimicrobial agents or immunosupressant treatment or prophylaxis.