345例艾滋病死亡病例的医院感染状况分析

目的探讨广东地区某传染病医院艾滋病住院死亡病例医院感染情况及其危险因素和对死亡的影响。方法对2001年1月—2011年12月该院345例艾滋病住院死亡病例的资料进行回顾性分析。结果 345例艾滋病住院死亡病例共发生医院感染47例,52例次,医院感染率为13.62%,感染例次率为15.07%;其中15例(31.91%)医院感染与死亡直接相关。医院感染部位以下呼吸道(18例次,34.62%)为主,其次为消化道(13例次,25.00%)和皮肤软组织(11例次,21.15%)等;病原体种类构成分别为细菌(12株,25.53%)、病毒(10株,21.28%)、真菌(6株,12.77%)及其他病原体(19株,40.43%)。医院感染的危险因素包括住院时间>30d、侵袭性操作、2个及以上部位的合并机会性感染、使用二联以上抗菌药物及CD4+T淋巴细胞计数<200个/μL。结论医院感染是艾滋病住院患者死亡的重要诱因之一。早期诊断和及时治疗机会性感染,缩短住院日,减少侵袭性操作,合理使用抗菌药物是预防和控制艾滋病患者发生医院感染的关键措施。

Healthcare associated infection in 345 HIV/AIDS death cases

ObjectiveTo evaluate healthcare associated infection （HAI） in HIV/AIDS death cases and risk factors for death in a hospital in Guangdong area.MethodsA retrospective case control study on 345 HIV/AIDS death cases in a hospital from January 2001 to December 2011was conducted.ResultsOf 345 HIV/AIDS death cases, 47 developed 52 times of HAI,HAI infection rate was 13.62%, case infection rate was 15.07%; 15（31.91%） cases of HAI were directly related to death. HAI usually occurred in lower respiratory tract （18 episodes, 34.62%）, gastrointestinal tract（13 episodes, 25.00%）,and skin and soft tissue （11 episodes, 21.15%）. Pathogens of HAI included bacteria（12 isolates，25.53%）, virus（10，21.28%）, fungus（6，12.77%）and others（19，40.43%）.Independent risk factors for HAI were length of hospital stay 〉30 days, invasive operation, opportunistic infection of at least two sites, combination use of antimicrobial agents, and CD4＋T lymphocyte 〈200/＆mu;l.ConclusionHAI is one of the important causes of death in hospitalized HIV/AIDS patients. Early diagnosis and treatment for the opportunistic infection, shortening of hospital stay, control of invasive operations, rational administration of antimicrobial agents are the key measures to prevent and control HAI in HIV/AIDS patients.