系统性红斑狼疮患者医院感染的特点及其危险因素分析  

Nosocomial Bacterial Infection in Patients with Systemic Lupus Erythematosus:An Analysis of Clinical Features and Risk Factors

作　　者：李志军[1] 王涛[1] 杨珂珂[1] 谢长好[1] 陈琳洁[1] 李茂胜[1] 

机构地区：[1]蚌埠医学院第一附属医院风湿免疫科,安徽蚌埠233004

出　　处：《中华医院感染学杂志》2009年第3期274-277,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解系统性红斑狼疮(SLE)患者发生医院感染的特点及其危险因素。方法将597例SLE患者根据其细菌学检查结果分为医院感染组与对照组进行对比分析。结果呼吸道与肺部感染占36.0%,尿路感染29.0%,血液感染19.9%,其他感染15.1%;75.8%的患者医院感染发生缓慢或隐匿,感染多系条件致病菌引起,其中G-杆菌占45.6%,G+球菌40.9%,其他病原菌13.9%;SLE发生医院感染的独立危险因素是:肺部病变>3个系统器官受损,血浆白蛋白<30g/L,长时间大剂量应用糖皮质激素(GC),应用超大剂量GC冲击疗法,GC联合应用细胞毒免疫抑制剂治疗,入院前应用广谱抗菌药物,住院时间>3周。结论SLE患者发生医院感染以呼吸道及肺部感染最常见,机会性G-杆菌和G+球菌是其主要病原菌;临床表现不同于一般病原菌感染,原发病情控制后应尽可能减少GC的用量,谨慎应用超大剂量GC和GC联合细胞毒免疫抑制剂;尽量缩短住院时间有可能减少SLE患者医院感染的发生。OBJECTIVE To investigate the clinical features and risks factors of nosocomial bacterial infection in patients with systemic lupus erythematosus （SLE）. METHODS Five hundred and ninety-seven patients with SLE were classed into two groups, the group of nosocomial bacterial infection and the control group according to the results of bacteriological examinations. A comparison was performed between the two groups. RESULTS According to the infection sites, 36% occurred in the respiratory tract and lungs, 29.0% in the urinary tract, 19.9% in the blood system and 15.1% in other tissues and organs. From them, 75.8% onsets of nosocomial bacterial infection were chronic or insidious. The pathogens of nosocomial bacterial infection were mostly opportunistic, 45.6 % were G^- bacilli, 40.9% G^＋ cocci and 13.9% were other bacteria. The eight major risk factors included lung disease, the more than 3 damaged organs or systems, plasma albumin under 30 g/L, long application of large dose glucocortieoid （GC）, treatment of super-dose GC, therapeutic alliance of GC and cytotoxic immunosuppressant usage, use of broad-spectrum antibiotics before hospitalization and the time in hospital over 3 weeks. CONCLUSIONS The respiratory tract and lungs are the commonest site of nosocomial bacterial infection in patients with SLE. Most of the pathogens may be opportunistic of G^- bacilli and G^＋ cocci. The clinical features are untypical. It may decrease the incidence of the nosocomial bacterial infection to diminish by decreasing dose and the course of GC treatment after the patientrs condition improved, select prudently application of super-dose GC, therapeutic alliance of CJC and cytotoxic immunosuppressants, cautiously use of broad-spectrum antibiotics and shorten the duration of hospitalization.

关 键 词：医院感染 病原菌 危险因素 系统性红斑狼疮 

分 类 号：R378[医药卫生—病原生物学]