狼疮性肾炎并发医院获得性感染的临床特点及相关因素分析

目的探讨狼疮性肾炎(LN)患者并发医院获得性感染的相关因素和细菌学特点。方法回顾性分析2008~2009年我科住院治疗的121例LN患者感染的可能原因,并分析感染的部位、细菌种类、治疗及转归。结果 121例LN患者中,29例发生医院获得性感染,占23.9%。LN患者医院内感染与疾病活动、大量尿蛋白、低血白蛋白、大剂量使用激素、住院天数显著相关(P0.05),与年龄、性别、血甘油三酯及球蛋白水平无显著相关(P0.05)。最常见的感染部位是呼吸道(48.3%)。感染的细菌以革兰阴性杆菌(44.4%)为主,其中最常见的是大肠埃希菌(26.1%)和肺炎克雷伯菌(21.7%)。29例并发医院获得性感染的患者中,治愈26例,2例死亡,1例放弃治疗。结论狼疮性肾炎患者易并发医院获得性感染,易感因素有疾病活动、24 h尿蛋白定量、血白蛋白、肾功能、血IgG、大剂量使用激素、住院天数等。

Analysis on the influential factors of hospital acquired infection in patients with lupus nephritis

Objective To investigate bacteriologic characteristics and influential factors of hospital acquired infection （HAI） in pa- tients with lupus nephritis. Methods Clinical data of 121 patients with lupus nephritis from the year 2008 to 2009 of our department were reviewed retrospectively, and the possible causes, sites of infection, bacterial species, treatment and prognosis were analysed. Results Twenty-nine of 121 （23.9%） patients had HAI, which was related with lupus activity, mass proteinuria, hypoalbumin, large dosage of hormones and length of hospitalization, but it has no relationship with age, sex, globulin and serum triglyceride. The most common site of HAI was in respiratory tract（48.3% ）. Bacterial culture results with HAI patients was mainly gram -negative bacilli （44.4%）. The most common was Escherichia coli （26.1% ） and Klebsiella pneumoniae （21.7%）. Among 29 HAI patients,26 cases were treated, 1 case gave up the treatment, and 2 died. Conclusion Patients with LN may predispose to HAI. The factors related to HAI are lupus activity, 24 - hour urinary protein malnutrition, hypoalbumin, renal insufficiency, lower IgG, the use of prednisone, and length of hospitalization, so we must pay more attention to them.