老年患者多药耐药菌医院感染影响因素分析  

Risk factors analysis of multidrug-resistant bacteria nosocomial infections in geriatric patients

作　　者：杨慧宁[1] 沈昫 梁子亮 张娜[1] 宋洋 张莹莹[1] 李慧 冀超[1] 谢秀彦 YANG Hui-ning;SHEN Xu;LIANG Zi-liang;ZHANG Na;SONG Yang;ZHANG Ying-ying;LI Hui;JI Chao;XIE Xiu-yan(General Hospital of Chinese People＇s Armed Police Forces, Beijing 100039, China)

机构地区：[1]中国人民武装警察部队总医院感染控制科,北京100039

出　　处：《中华医院感染学杂志》2018年第8期1183-1186,1228,共5页Chinese Journal of Nosocomiology

基　　金：国家科技支撑基金资助项目(2015BAK08B00)

摘　　要：目的探索老年患者多药耐药菌医院感染的影响因素。方法本研究采用非匹配病例对照研究回顾性调查医院2015年-2017年老年住院患者30 099例,分析发生多药耐药菌感染的影响因素(年龄、性别、住ICU、手术次数、住院时间、术后用药时间、使用呼吸机、进行中心静脉插管、插尿管),使用卡方检验进行单因素分析,使用Logistic回归模型进行多因素分析。结果 691例多药耐药菌感染患者检出病原菌834株,多药耐药菌以MDRAB 304株占36.45%为主,其次为CRE 127株占15.23%;多药耐药菌感染患者科室分布中内科有384例占55.57%、外科有307例占44.43%;Logistic回归分析结果显示,年龄越大、男性、住ICU、手术次数>2次、住院时间≥31d、术后用药时间>2周、使用呼吸机、进行中心静脉插管、插尿管均为老年患者多药耐药菌感染的影响因素。结论老年患者多药耐药菌感染的影响因素较多,尤其是住院时间≥31d、术后用药时间>2周的患者应重点关注,通过严格落实消毒、隔离、标准预防、抗菌药物管理等综合措施,可有效控制感染源、切断感染途径,降低多药耐药菌感染的发生。OBJECTIVE To explore the risk factors of multidrug-resistant bacteria nosocomial infections in geriatric patients. METHODS This study used a non-matching case-control study to retrospectively review 30099 geriatric patients hospitalized in our hospital from 2015 to 2017. The risk factors （age, gender, ICU or not, times of opera- tion, hospitalization days, postoperative medication time, respirator, CV, and catheter） for multidrug-resistant bacteria infection were analyzed, the chi-square test was used for univariate analysis, and logistic regression model was used for multivariable analysis. RESULTS Totally 834 strains of pathogens were detected from 691 patients with multidrug-resistant bacteria infection. The multidrug-resistant bacteria were mainly 304 strains of MDR-AB, accounting for 36.45%, followed by 127 strains of CRE, accounting for 15.23%. The main departments of pa- tients with multidrug-resistant bacteria infection were internal medicine （384 cases, 55.57 %） and surgery （307 ca- ses, 44.43%）. The logistic regression analysis showed that elder age, male, admission in ICU, times of operatio n〉2, hospitalization days≥31 d, postoperative medication time〉2 weeks, respirator, CV, and catheter were risk factors for multidrug-resistant bacteria nosocomial infection in geriatric patients. CONCLUSION Geriatric pa- tients with multidrug-resistant bacteria infection are related to many factors. Patients who have been hospitalized for more than 31 d and postoperative medicated for more than 2 weeks should be focused on. The implementation of comprehensive measures, such as disinfection, isolation, standard prevention, antibiotic management, can ef- fectively control the source of infection and cut off the routes Of infections, which can effectively reduce the occur-rence of multidrug-resistant bacteria infections.

关 键 词：老年患者 多药耐药菌 医院感染 影响因素 

分 类 号：R181.3[医药卫生—流行病学]