慢性肾功能不全患者医院感染病原菌特点及影响因素分析  

Characteristics and risk factors of nosocomial infections in patients with chronic renal insufficiency

作　　者：揭乐琴 柳亿 张孝亮 卢会丽 何东元[2] JIE Le-qin , LIU Yi, ZHANG Xiao-liang, LU Hui-li, HE Dong-yuan(Anji People＇s Hospital, Zhejiang Hospital, Anji, Zhejiang 313300, Chin)

机构地区：[1]浙江医院安吉分院肾内科,浙江安吉313300 [2]浙江医院肾内科,浙江杭州310007

出　　处：《中华医院感染学杂志》2018年第6期863-865,875,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2014KYB008);湖州市科技局公益性技术应用研究基金资助项目(2015GY40)

摘　　要：目的探讨慢性肾功能不全患者医院感染病原菌特点及影响因素。方法选择于2015年5月-2017年5月期间医院收治的慢性肾功能不全患者893例,发生医院感染60例;采集医院感染患者的痰液、血液和尿液等标本,分离培养细菌,采用生物鉴定系统进行细菌鉴定;统计分析患者性别、年龄、反复侵袭性操作、血浆白蛋白水平、住院时间等情况。结果 893例慢性肾功能不全患者中有60例发生医院感染,医院感染发生率为6.72%;60例医院感染患者共分离出病原菌71株,其中革兰阴性菌41株占57.75%、革兰阳性菌22株占30.99%、真菌8株占11.27%;主要革兰阴性菌对头孢地嗪和美罗培南耐药率较高,均>85%;主要革兰阳性菌对青霉素耐药率较高,均>70%;Logistic多元回归分析结果显示,年龄、反复侵袭性操作、血浆白蛋白水平、住院时间为慢性肾功能不全患者医院感染的影响因素。结论慢性肾功能不全患者医院感染病原菌以革兰阴性菌为主,需严格根据病原菌和耐药试验,合理使用抗菌药物,可降低慢性肾功能不全医院感染发生率。OBJECTIVE To investigate the characteristics and risk factors of nosocomial infections in patients with chronic renal insufficiency.METHODS A total of 893 patients with chronic renal insufficiency in our hospital from May 2015 to May 2017 were selected,and nosocomial infections occurred in 60 cases.Sputum,blood and urine specimens from patients with nosocomial infections were collected for bacterial isolation and culture,and the bacteria were identified with VITEK biological identification system of BioMerieux.Genders,age,repeated invasive procedures,plasma albumin levels,and hospital stay were statistically analyzed.RESULTS Of the 893 patients with chronic renal insufficiency,60 cases had nosocomial infections,and the incidence of nosocomial infections was 6.72%.A total of 71 strains of pathogens were isolated from 60 cases of patients with nosocomial infections,including 41 strains of gram-negative bacteria accounting for 57.75%,22 strains of gram-positive bacteria accounting for 30.99%,and 8 strains of fungi accounting for 11.27%.The main gram-negative bacteria had high resistant rates to cefepime and meropenem,which were all over 85%.The main gram-positive bacteria had high resistant rate to penicillin,which were all over 70%.The results of multivariable logistic regression analysis showed that,age,repeated invasive operation,plasma albumin level and hospitalization time were risk factors for nosocomial infections in patients with chronic renal insufficiency.CONCLUSION Gram-negative bacteria are the main pathogens of nosocomial infections in patients with chronic renal insufficiency.It is necessary to rationally use antibiotics according to pathogenic bacteria and drug resistance test to reduce the incidence of chronic renal insufficiency.

关 键 词：慢性肾功能不全 医院感染 病原菌 影响因素 

分 类 号：R378[医药卫生—病原生物学]