老年糖尿病患者医院感染的临床特点及影响因素分析  

Clinical characteristics and influencing factors for nosocomial infections in elderly patients with diabetes mellitus

作　　者：吴晓霞[1] 左阿芳 吴建义[1] 宋迎香[1] 孙丹琴[1] 

机构地区：[1]浙江省人民医院杭州医学院附属人民医院干部科,浙江杭州310024

出　　处：《中华医院感染学杂志》2017年第22期5122-5125,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2017KY211)

摘　　要：目的探讨老年糖尿病患者医院感染的临床特点及影响因素分析。方法选取2013年1月-2016年12月医院住院的老年糖尿病患者300例临床资料,分析患者感染率、病原菌分布并分析老年糖尿病医院感染相关影响因素。结果 300例老年糖尿病患者医院感染42例,感染率为14.0%;42例老年糖尿病医院感染患者中,呼吸道感染、泌尿道感染、皮肤软组织感染、消化道感染分别为15例、11例、8例、5例,构成比为35.7%、26.2%、19.0%、11.9%,42例老年糖尿病医院感染患者共培养出病原菌67株,其中革兰阳性菌、革兰阴性菌、真菌分别为12株、41株、14株,构成比分别为17.9%、61.2%、20.9%,革兰阳性菌主要为耐甲氧西林金黄色葡萄球菌和肠球菌,革兰阴性菌主要为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌;老年糖尿病患者医院感染和年龄、病程、糖化血红蛋白、空腹血糖、并发症、住院时间、侵入性操作及应用抗菌药物种类有关(P<0.05);年龄>70岁、病程≥5年、糖化血红蛋白>9%、空腹血糖≥15mmol/L、有并发症、住院时间≥4周、有侵入性操作、抗菌药物种类≥2种是老年糖尿病患者医院感染的独立危险因素(P<0.05)。结论老年糖尿病患者医院感染率较高,主要感染部位为呼吸道感染,主要病原菌为革兰阴性菌,临床应对高龄、病程长、糖化血红蛋白和空腹血糖高、合并并发症、住院时间长、抗菌药物种类多、有侵入性操作患者高度重视,预防医院感染的发生。OBJECTIVE To explore the clinical characteristics and influencing factors for nosocomial infections in elderly patients with diabetes mellitus.METHODS The clinical data were collected from 300 elderly patients with diabetes patients who were hospitalized from Jan 2013 to Dec 2016.The infection rate and distribution of patho-gens were observed,and the related influencing factors for the nosocomial infections were analyzed.RESULTS Of the 300 elderly patients with diabetes mellitus,42 had nosocomial infections,with the infection rate 14.0%.A-mong the 42 elderly patients with nosocomial infections,15（35.7%）had respiratory tract infections,11（26. 2%）had urinary tract infections,8（19.0%）had skin and soft tissue infections,and 5（11.9%）had gastrointes-tinal tract infections.A total of 67 strains of pathogens were isolated from the 42 elderly diabetes mellitus patients with nosocomial infections,of which 12（17.9%）were gram-positive bacteria,41（61.2%）were gram-negative bacteria,and 14（20.9%）were fungi;the methicillin-resistant Staphylococcus aureus and Enterococcus were the predominant species of the gram-positive bacteria;the Pseudomonas aeruginosa,Klebsiella pneumoniae and Acin-etobacter baumannii were dominant among the gram-negative bacteria.The incidence of nosocomial infections in the elderly patients with diabetes mellitus was associated with the age,disease course,glycosylated hemoglobin, fasting blood glucose,complications,length of hospital stay,invasive operations and types of used antibiotics（P〈0.05）.The independent risk factors for the nosocomial infections in the elderly patients with diabetes mellitus included the more than 70 years of age,disease course no less than 5 years,glycosylated hemoglobin more than 9%,fasting blood glucose no less than 15mmol/l,complications,length of hospital stay no less than 4 weeks and use of no less than 2 types of antibiotics（P〈0.05）.CONCLUSION The incidence of nosocomial infections is high among the elderly patients with diabetes melli

关 键 词：老年 糖尿病 医院感染 病原菌 危险因素 

分 类 号：R587.1[医药卫生—内分泌]