泌尿外科患者医院感染病原菌分布与感染危险因素分析  

The pathogen bacteria distribution characteristics and related risk factors analysis in patients with nosocomial infection in urology department

作　　者：申升[1] 李琴[1] 朱春丽[1] 吴家清[1] 周结学[1] 蒙善东[1] 马娟[1] 邓庚国 刘东[1] 

机构地区：[1]广东省第二人民医院泌尿外科,广州510317

出　　处：《中华腔镜泌尿外科杂志（电子版）》2017年第6期22-25,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省医学科研基金立项项目(B2016104)

摘　　要：目的了解泌尿外科住院患者医院感染的情况、病原菌的分布特点、耐药性,分析可能造成感染的危险因素。方法回顾分析了自2016年1月至2016年12月在广东省第二人民医院泌尿外科住院的549例患者的病史资料,统计分析患者医院感染的发生情况、细菌培养和药敏试验结果,以及相关易感因素(如性别、年龄、住院时间、基础疾病等)。结果所有患者中有249例患者确诊为医院感染,感染率为45.36%。249例患者中,泌尿道感染患者最多,为132例(53.01%),血液感染患者最少,仅为10例(4.02%),其余感染部位有呼吸系统感染65例(25.70%)、手术切口感染24例(9.64%)和消化系统感染19例(7.63%)。患者送检标本中检出病原菌最多的为大肠埃希菌92例(36.95%),其余检出率较高的分别为肺炎克雷伯菌40例(16.06%)、铜绿假单胞菌33例(13.25%)、金黄色葡萄球菌27例(10.84%)、产气肠杆菌15例(6.02%)等。两种检出率较高的革兰氏阴性菌大肠埃希菌和肺炎克雷伯菌的药敏结果提示,革兰氏阴性菌对头孢哌酮、头孢吡肟、阿米卡星较为敏感,耐药率均<20%;而对亚胺培南、美罗培南等碳青霉烯类药物的敏感性基本为100%。两种检出率较高的革兰氏阳性菌金黄色葡萄球菌和粪肠球菌的药敏结果提示,革兰氏阳性菌对万古霉素、替考拉宁和利奈唑胺的敏感性较高,接近100%,而对青霉素、红霉素、环丙沙星等的耐药性较高,均>50%。多因素Logistic分析结果显示,年龄≥60岁(OR=1.947),住院时间≥7 d(OR=2.057)、合并糖尿病(OR=2.342)和留置导尿管(OR=1.942)是患者发生医院感染的独立危险因素。结论泌尿外科患者发生医院感染的部位多为泌尿道,革兰氏阴性菌(以大肠埃希菌和肺炎克雷伯菌为主)为主要的病原菌,年龄、住院天数、留置导尿管和合并糖尿病是患者发生医院感染的独立危险因素。Objective To explore pathogen infection condition, pathogen bacteria distribution and their antibiotic resistance in patients with nosocomial infection in urology department, and to analyze risk factors of nosocomial infection. Methods A retrospective study of 549 cases from January 2016 to December 2016 in urology department in our hospital were performed. The occurrence of nosocomial infection, results of bacterial culture and susceptibility test and susceptible factors were recorded and analyzed. Results Two hundred and fourty nine patients were diagnosed with nosocomial infection, and the infection rate was 45.36%. In these 249 cases, the ratio of infection in urinary tract was the highest （132 cases, 53.01%）, and the ratio of infection in blood was the lowest （10 cases, 4.02%）. The other infected systems or organs included respiratory system （65 cases, 25.70%）, surgical incision＆nbsp;（24 cases, 9.64%）, and digestion system （19 cases, 7.63%）. The major pathogen bacteria isolated from patents＇ samples was Escherichia coli （92 cases, 36.95%） and other bacterium included Klebsiella penumoniae （40 cases, 16.06%）, Pseudomonas aeruginosa （33 cases, 13.25%）, Staphylococcus aureus （27 cases, 10.84%）, Enterobacter aerogenes （15 cases, 6.02%） and so on. The results of bacterial susceptibility test on two major gram-negative bacterium （Escherichia coli and Kelbisella penumoniae） showed that the ratio of their resistance to cefoperazone, cefepime and amikacin was less than 20% and they were susceptible to imipenem and meropenem. Meanwhile, the result of bacterial susceptibility test on two gram-positive bacterium （Staphylococcus aureus and Enterococcus faecalis） showed that they were susceptible to vacomycin, teicoplanin, and linezolid. Age more than 60 years （OR=1.947）, hospital stay more than 7 days （OR=2.057）, diabetes （OR=2.342） and indwelling catheter （OR=1.942） were independent risk factors of nosocomial infection. Conclusion Nosocomial infection o

关 键 词：泌尿外科 医院感染 病原菌 危险因素 

分 类 号：R699[医药卫生—泌尿科学]