老年患者医院获得性血流感染的临床回顾性研究  

Hospital-acquired bloodstream infections in geriatric wards： a retrospective clinical study

作　　者：柏淑禹[1] 张伟[1] 

机构地区：[1]南京大学医学院附属鼓楼医院老年病科,210008

出　　处：《中华老年医学杂志》2016年第8期871-875,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年病房医院感染血流感染病例的临床特点、病原学特征及其他相关因素，为临床诊疗提供科学依据。方法对我院老年病房2010年6月至2015年10月医院获得性血流感染患者的相关因素及临床特征进行回顾性分析。结果老年血流感染患者64例，基础疾病以恶性肿瘤（39．1％）及2型糖尿病（32．8％）为主；原发血流感染53例，占82．8％；继发性血流感染11例，占17．2％；原发感染病灶以呼吸道、泌尿道和肝胆系统为主。13例患者死亡，病死率高达20．3％。多因素条件Logistic逐步回归分析显示，中心静脉置管或输液港≥7d（OR-49．51）、使用质子泵抑制剂药物≥3d（OR-13．63）是老年患者血流感染发生的独立危险因素；64例患者中，共检出66株病原菌。G＋菌以凝固酶阴性葡萄球菌属最常见（18．2％）；G-菌以埃希菌属（18．2％）和克雷伯菌属（15．2％）多见，二者产超广谱β-内酰胺酶株为54．5％。结论血流感染严重影响老年患者的预后。减少侵袭性操作、积极防治肿瘤、改善内环境、保护重要脏器功能，是降低老年病房血流感染发生率的主要措施。Objective To investigate the clinical and pathogenic features and other related factors of hospital-acquired bloodstream infections （HABSI） in geriatric wards, in order to provide the scientific basis for clinical diagnosis and therapy. Methods Clinical characteristics and other related factors of HABSI in patients admitted to the Department of Geriatrics of our hospital from June 2010 to October 2015 were retrospectively analyzed. Results Of the 64 elderly patients with HABSI, malignant tumor （39.1%） and type 2 diabetes mellitus （32.8%） were among the main disorders for their admission to the hospital. There were 53 cases of primary bloodstream infections and 11 cases of secondary bloodstream infections, accounting for 82.8% and 17.2%, respectively. Primary infections involved mostly the respiratory, urinary and hepatobiliary systems. 13 patients died, giving a fatality rate of 20.3%. Multiple logistic regression analysis showed that the retention time of central venous catheters or implantable venous access ports was ≥7 days （OR=49.51） and the duration of proton pump inhibitor administration was ≥3 days （OR= 13.63）, and these were independent risk factors for HABSI in elderly patients. A total of 66 strains of pathogenic bacteria were detected from the 64 patients. The most common G＋ type was coagulase negative staphylococcus （18.2%） and the most common G- bacteria were Escherichia coli （18.2%） and Klebsiella pneumonia （15.2%）, with the latter two making up 54.5% of the extended-spectrum β-lactamase （ESBL）-produeing strains. Conclusions HABSI can seriously affect the prognosis of elderly patients. Reduction in invasive procedures, active prevention and treatment of tumors, improvement of the internal environment and protection of vital organ functions are the main measures to reduce the bloodstream infection rate in geriatric wards.

关 键 词：血流感染 插管相关感染 

分 类 号：R515.3[医药卫生—内科学]