ICU老年患者尿路感染的临床分析  

Clinical analysis of urinary tract infections in elderly patients of ICU

作　　者：杨建锋[1] 张玉泉[1] 刘清涛[1] 

机构地区：[1]鹤壁职业技术学院,河南鹤壁458030

出　　处：《中华医院感染学杂志》2014年第6期1458-1460,共3页Chinese Journal of Nosocomiology

基　　金：鹤壁市卫生局基金资助项目(YH-2009B-1032)

摘　　要：目的分析ICU老年患者尿路感染的病原菌分布、危险因素及预防措施,为降低ICU老年患者尿路感染提供参考。方法将2011年6月-2012年6月住ICU进行留置导尿管的245例老年患者为观察组,按照是否发生留置尿管相关性尿路感染(CAUTI)分为感染组74例和非感染组171例,记录比较两组留置尿管时间、发病率及CAUTI的病原菌分布和危险因素,同时对2012年6月之后应用集束化预防措施的138例ICU留置导尿患者为对照组,探讨其对CAUTI的预防效果,采用SPSS18.0软件进行统计分析。结果感染组74例CAUTI患者无症状菌尿56例占75.7%,有症状菌尿18例占24.3%;分离出133株病原菌,其中革兰阴性菌48株占36.1%,革兰阳性菌32株占24.1%,真菌53株占39.8%;高龄(>75岁),患有脑梗死、脑出血、糖尿病等基础疾病,意识障碍、留置导尿管时间长及广谱抗菌药物不合理使用等,均是ICU老年患者发生尿路感染的危险因素;应用集束化治疗措施后,对照组患者导尿管留置时间及留置<2周患者CAUTI发病率均显著低于观察组(P<0.05)。结论 ICU老年患者尿路感染发生率高,应引起高度重视,根据发生的危险因素采取集束化治疗措施,以减少尿路感染的发生。OBJECTIVE To analyze the distribution of pathogens causing urinary tract infections in elderly patients of ICU, observe the risk factors, and put forward the prevention measures so as to reduce the incidence of urinary tract infections. METHODS A total of 245 elderly patients, who underwent the catheter indwelling in ICU from Jun 2011 to Jun 2012, were chosen as the observation group and divided into the infection group with 74 cases and the non-infection group with 171 cases according to the status of catheter-associated urinary tract infections （CAUTI）, then the catheter indwelling time and morbidity rate were recorded, the distribution of the pathogens causing CAUTI and the risk factors were observed; totally 138 catheter indwelling patients who have taken the cluster prevention measures since Jun 2012 were set as the control group, and the effect on prevention of CAUTI was observed; the statistical analysis was performed with the use of SPSS 18.0 software. RESULTS Among the 74 cases of CAUTI in the infection group, there were 56 （75.7%） cases of asymptomatic bacteriuria and 18 （24.3%） cases of symptomatic bacteriuria. Totally 133 strains of pathogens have been isolated, including 48 （36. 1%） strains of gram-negative bacteria, 32 （24.1%） strains of gram-positive bacteria, and 53 （39.8% ） strains of fungi. The risk factors for the urinary tract infections in the elderly patients of ICU included the advanced age （more than 75 years）, cerebral infarction, diabetes, disturbance of consciousness, long catheter indwelling time, and unreasonable use of broad spectrum antibiotics. After the implementation of cluster interventions, the incidence of CAUTI in the patients with catheter indwelling time less than two weeks was significantly lower in the control group than in the observation group（P〈0.05）. CONCLUSION The incidence of urinary tract infections is high in the elderly patients of ICU, which should be attached great importance to; it is necessary to take cluster interventions ac

关 键 词：重症监护护病房 老年患者 留置尿管 尿管相关性尿路感染 

分 类 号：R691.3[医药卫生—泌尿科学]