失代偿期乙型肝炎肝硬化患者发生医院感染临床特点及危险因素分析*

目的 分析失代偿期乙型肝炎肝硬化患者住院期间发生医院感染的临床特点及其危险因素。方法 2016年2月～2018年12月我院收治的失代偿期乙型肝炎肝硬化患者100例,查阅出院病历资料,分析患者发生医院感染的临床特点,应用Logistic 回归分析影响感染发生的因素。结果 100例失代偿期乙型肝炎肝硬化患者在住院期间发生医院感染者25例(25.0%),其中呼吸道感染10例(40.0%),腹膜感染7例(28.0%),肠道感染4例(16.0%);大肠埃希菌感染5例(29.4%),金黄色葡萄球菌感染4例(23.5%),肺炎克雷伯菌感染2例(11.8%),铜绿假单孢菌感染2例(11.8%),肺炎链球菌感染2例(11.8%);单因素分析显示不同性别、是否发生肝性脑病、是否预防性应用抗菌药物患者感染发生率无显著性差异(P>0.05),而不同年龄、住院时间长短、不同肝功能分级、是否行侵入性操作、血清白蛋白和血清胆红素高低、有无腹水和是否应用抗病毒药物患者医院感染发生率差异显著,经多因素回归分析显示年龄≥60岁(OR=4.176,P=0.023)、住院时间≥1月(OR=44.116,P=0.021)、肝功能分级差(OR=5.160,P=0.009)、进行了侵入性操作(OR=5.265,P=0.003)和有腹水(OR=2.921,P=0.033)为影响患者发生院内感染的独立危险因素。结论 失代偿期乙型肝炎肝硬化患者在住院期间易发生医院感染,对于感染高危人群应予以高度关注,重视手卫生和适度隔离,以减少院内感染的发生。

Clinical characteristicsof and risk factors for nosocomial infections in patients with hospitalized decompensated hepatitis B liver cirrhosis

Objective The purpose of this study was to explore the clinical feature of and risk factors for nosocomial infections in patients with hospitalized decompensated hepatitis B liver cirrhosis.Methods 100 patients with decompensated hepatitis B liver cirrhosis were recruited in our hospital between February 2016 and December 2018.The clinical characteristics of patients with nosocomial infection were retrospectively analyzed,and the risk factors for infection were evaluated by Logistic regression analysis.Results Among the 100 patients with decompensated hepatitis B cirrhosis,25(25.0%)had nosocomial infection,and among them,10(40.0%)were respiratory tract infection,7(28.0%)were spontaneous bacteria peritonitis,4(16.0%)were gut infection;the infected bacteria strains were Escherichia Coli in 5(29.4%),Staphylococcus Aureus in 4(23.5%),Klebsiella Pneumonia in 2(11.8%),Pseudomonas Aeruginosa in 2(11.8%)and Streptococcus Pneumonia in 2(11.8%);univariate analysis showed that there were no significant differences between male and female patients,or patients with or without hepatic encephalopathy or prophylactic antibiotics(P>0.05),while there were significant differences between young and elderly patients,patients with short or long hospital stay,with different Child-Pugh scores,with or without invasive check-up,with lower serum albumin and bilirubin levels,with or without ascites and with or without anti-viral therapy and multivariate Logistic analysis showed that older than 60 years(OR=4.176,P=0.023),hospital stay longer than one month(OR=44.116,P=0.021),poor Child-Pugh score(OR=5.160,P=0.009),invasive check-up(OR=5.265,P=0.003)and ascites(OR=2.921,P=0.033)were the independent risk factors for nosocomial infections.Conclusion Patients with decompensated hepatitis B liver cirrhosis are prone to nosocomial infection,and clinicians should take risk factors into consideration in this settings to decrease the occurrence of nosocomial infection.