呼吸科住院病例医院感染影响因素及病原菌耐药性分析

目的 探讨呼吸科住院病例医院感染病原菌分布及耐药性。方法 通过查阅住院病历的方法,回顾性分析2018年3月至2020年1月郑州市某医院呼吸科接受治疗的982例住院病例资料。统计发生医院感染情况、感染病原菌分布及耐药性,采用单因素和多因素Logistic回归分析呼吸科住院病例医院感染发生的影响因素。结果 共纳入住院病例982例,发生医院感染59例,感染率为6.01％,以下呼吸道感染为主（22例,37.29%）。共培养分离病原菌86株,其中革兰阴性菌41株（47.67%）,革兰阳性菌12株（13.96%）,真菌33株（38.37%）。革兰阴性菌以铜绿假单胞菌和肺炎克雷伯菌为主（20株,23.26%）,革兰阳性菌以金黄色葡萄球菌为主（9株,10.47%）,真菌感染以白色念珠菌为主（22株,25.58%）。铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦和替加环素的耐药率为100%,对头孢唑啉、头孢曲松和头孢替坦的耐药率均在80.00%以上,对妥布霉素敏感。肺炎克雷伯菌对常用抗菌药物的耐药率为12.50%~25.00%。金黄色葡萄球菌对青霉素G的耐药率为 83.33%,对红霉素的耐药率为50.00%,对利福平、利奈唑胺、万古霉素、四环素和替加环素均敏感。白色念珠菌对氟康唑、伊曲康唑、两性霉素B和伏立康唑均敏感。单因素分析显示,年龄、合并基础疾病、有侵入性操作、抗生素应用不合理、住院时间、激素与免疫抑制剂应用与呼吸科住院病例医院感染发生有关（均P<0.05）;多因素Logistic回归分析结果显示,年龄为61~78岁（OR=2.115）、住院时间≥15 d（OR=2.895）、合并基础疾病（OR=1.636）、有侵入性操作（OR=3.267）均是呼吸科住院病例医院感染发生的危险因素。结论 呼吸科住院病例医院感染多发生在下呼吸道,以革兰阴性菌和真菌为主,对多数药物均具有一定的耐药性,而年龄61~78岁、住院时间≥15 d、合并基础疾病、有侵入性操作均是呼吸科住院病例医院感染发生的独立危险因素。

Influencing factors of nosocomial infection and drug resistance of pathogenic bacteria in respiratory inpatients

Objective To investigate the distribution and drug resistance of pathogenic bacteriaofnosocomial infections in respiratory inpatients. Methods The data of 982 inpatients who received treatment in the respiratory department of a hospital in Zhengzhou from March 2018 to January 2020 were retrospectively analyzed by consulting the inpatient medical records.The occurrence of nosocomial infection,the distribution of infective pathogens and drug resistance were statistically analyzed,and the influencing factors for the occurrence of nosocomial infection in respiratory inpatient cases were analyzed by univariate and multivariate Logistic regression. Results A total of 982 inpatient cases were included,59 nosocomial infections occurred,and the infection rate was 6.01%,with lower respiratory tract infections predominating in 22 cases(37.29%).A total of 86 strains of pathogenic bacteria were isolated by co-culture,including 41 strains of Gramnegative bacteria(47.67%),12 strains of Gram-positive bacteria(13.96%),and 33 strains of fungi(38.37%).The Gramnegative bacteria were mainly Pseudomonas aeruginosa and Klebsiellapneumoniae(20 strains,23.26%),the Gram-positive bacteria were mainly Staphylococcus aureus(9 strains,10.47%),and the fungal infections were mainly Candida albicans(22 strains,25.58%).Pseudomonas aeruginosa was 100% resistant to ampicillin,ampicillin/sulbactam and tigecycline,more than 80.00% resistant to cefazolin,ceftriaxone and cefotetan,and susceptible to tobramycin.The resistance rate of Klebsiellapneumoniae to commonly used antimicrobials ranges from 12.50% to 25.00%.Staphylococcus aureus was83.33% resistant to penicillin G,50.00% resistant to erythromycin,and sensitive to rifampicin,linezolid,vancomycin,tetracycline,and tigecycline.Candida albicans was sensitive to fluconazole,itraconazole,amphotericin B,and voriconazole. Univariate analysis showed that age,comorbid underlying diseases,invasive procedures,unjustified antibiotic use,length of hospital stay,hormone and immunosuppressant use were associated with the occurrence of nosocomial infections in respiratory inpatient cases(all P< 0.05).Multivariate Logistic regression analysis showed that age of 61-78 years old(OR=2.115),length of hospital stay ≥15 d(OR=2.895),comorbid underlying diseases(OR=1.636),and invasive procedures(OR=3.267)were all independent risk factors for nosocomial infection in hospitalized respiratory patients.Conclusion Nosocomial infection of respiratory inpatients mostly occurs in the lower respiratory tract and are dominated by Gram-negative bacteria and fungi,which have some resistance to most drugs,while age 61-78 years,length of hospital stay ≥ 15 d,comorbid underlying diseases,and invasive procedures are all independent risk factors for the occurrence of nosocomial infections in respiratory inpatient cases.