急诊革兰阳性菌感染危险因素分析  

Analysis of risk factors related to infections by gram-positive bacteria in emergency department patients

作　　者：唐韵[1] 曹同瓦[2] 刘珏[1] 翁丽贞[3] 

机构地区：[1]复旦大学医学院附属华山医院静安分院急诊科,上海200040 [2]复旦大学医学院附属华山医院静安分院重症医学科,上海200040 [3]复旦大学医学院附属华山医院静安分院检验科,上海200040

出　　处：《实用医院临床杂志》2014年第3期85-87,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨本院急诊科病房革兰阳性菌感染患者的危险因素,为其防治提供科学依据。方法回顾性分析本院急诊科感染病例中103例革兰阳性菌感染情况。采用单因素分析和多因素Logistic回归分析其危险因素。结果分离患者血液、尿液、痰、胆汁、穿刺液、分泌液、脓汁及伤口引流液送检标本共1796份,检出阳性标本631份,总菌株培养检出阳性率为35.1%。分离出病原菌共593株,其中革兰阳性菌169株。465例感染病例中有103例检获革兰阳性菌感染,占22.2%。多因素Logistic回归分析发现,中心静脉置管、慢性肾功能不全、住院天数≥20 d是急诊科革兰阳性菌感染的独立危险因素。结论医院急诊科革兰阳性菌感染率在逐年增高,有针对性地合理选用抗生素,谨慎使用有肾毒性药物,保护肾功能,减少侵入性置管,缩短住院天数,将有助于控制医院急诊科革兰阳性菌感染。Objective Objectives To study the risk factors related to the infections by gram-positive bacteria and to discuss how to control .Methods A case control study was performed .Data of 103 cases of nosocomial infection caused by gram-positive bacte-ria were analyzed .As a control ,the 362 cases of nosocomial infection caused by other bacteria were selected at the same time .The uni-variate analysis and multivariate Logistic regression were used for statistics analysis .Results During the period of 3 years,1796 sam-ples were obtained,in which positive samples were 631（35.1%）,and 593 strains were separated,among which G＋bacteria were 169. There were totally 465 patients with the infections by gram-positive bacteria （ incidence rate was 22.2%） .Results from unconditioned Logistic regression analysis showed that the risk factors were the central venous catheterization ,the chronic kidney insufficiency and the length of hospital stay .Conclusion There was an obvious ascending trend of infection rate caused by gram-positive bacteria in emer-gency department .The drug resistant rate is high in G＋strains.The effective strategies and measures ,the precautional use of renal toxici-ty drugs,the reduction of unnecessary central venous catheter indwelling and the decrease of the length of hospital stay can reduce the incidence rate of the infections .

关 键 词：革兰阳性菌 医院感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]