医院重症监护室院内感染及预后的影响因素分析  

Influencing factors of nosocomial infection and prognosis in intensive care unit

作　　者：陈恩平[1] 胡旭钢 李秀央[1] 胡艳 蒋晓霞 曹识宇 Chen Enping;Hu Xugang;Li Xiuyang;Hu Yan;Jiang Xiaoxia;Cao Shiyu(Department of Epidemiology&Biostatistics,Zhejiang University,Hangzhou 310058,China;Department of Disease Control and Prevention,the 903rd Hospital of PLA,Hangzhou 310004,China)

机构地区：[1]浙江大学流行病与卫生统计学科系,杭州310058 [2]联勤保障部队第九〇三医院疾病预防控制科,杭州310004

出　　处：《国际流行病学传染病学杂志》2022年第3期192-195,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的了解联勤保障部队第九〇三医院ICU医院感染(以下简称"院感")的相关情况,以及院感发生及死亡的相关危险因素。方法回顾性分析2015—2019年间在联勤保障部队第九〇三医院的ICU住院1122例患者发生院感的情况,采用Logistic回归模型分析院感发生的危险因素,采用Kaplan-Meier和Cox回归模型分析院感患者死亡的危险因素。结果2015—2019年,该院ICU发生院感人数为497例,院感率为44.30%。>60岁(OR=1.76,95%CI:1.33~2.34)、男性(OR=1.65,95%CI:1.24~2.19)、联用抗菌药物(OR=3.89,95%CI:2.88~5.26)、使用呼吸机(OR=2.26,95%CI:1.65~3.10)、中心静脉置管(OR=5.14,95%CI:1.18~22.46)、留置尿管(OR=4.41,95%CI:1.80~10.82)是院感发生的危险因素。对环境致病菌进行监测(OR=0.67,95%CI:0.49~0.93),可以降低院感发生率。在发生院感的患者中,联用抗菌药物(HR=0.45,95%CI:0.29~0.70)及环境致病菌监测(HR=0.01,95%CI:0~0.02)可以降低院感患者的死亡风险。结论该院ICU医院感染发生率高,需重点关注>60岁、男性、联用抗菌药物、使用呼吸机、中心静脉置管、留置尿管患者的院感发生情况。对院感患者应重视抗菌药物的联用,同时加强环境致病菌监测,可以降低患者死亡率。Objective To understand the related situation of nosocomial infection in intensive care unit(ICU)of the 903rd Hospital of PLA,and the risk factors of nosocomial infection and death.Methods The incidence of nosocomial infection among 1122 patients who were hospitalized in ICU of the 903rd Hospital of PLA from 2015 to 2019 was retrospectively analyzed.Logistic regression was used to analyze the risk factors for the occurrence of nosocomial infection.Kaplan-Meier and Cox regression method were used to analyze the risk factors of death in patients with nosocomial infection.Results From 2015 to 2019,there were 497 patients with nosocomial infection in ICU and the rate of nosocomial infection was 44.30%.Patients over 60 years old(OR=1.76,95%CI:1.33-2.34),males(OR=1.65,95%CI:1.24-2.19),combined use of antibiotics(OR=3.89,95%CI:2.88-5.26),use of ventilator(OR=2.26,95%CI:1.65-3.10),central venous catheter(OR=5.14,95%CI:1.18-22.46),indwelling catheter(OR=4.41,95%CI:1.80-10.82)were risk factors for the occurrence of nosocomial infection.Monitoring of environmental pathogens could reduce the incidence of nosocomial infection(OR=0.67,95%CI:0.49-0.93).In patients with nosocomial infection,combined use of antibiotics(HR=0.45,95%CI:0.29-0.70)and monitoring of environmental pathogens(HR=0.01,95%CI:0-0.02)could significantly reduce the risk of death.Conclusions The incidence of nosocomial infection in ICU of the 903rd Hospital of PLA is high.Patients over 60 years old,males,patients with combined use of antibiotics,use of ventilator,central venous catheter,indwelling urinary catheter should be paid more attention.For patients with nosocomial infection,the combined use of antibacterial drugs and environmental pathogen monitoring should be strengthened to reduce the mortality in ICU.

关 键 词：交叉感染 重症监护室 医院感染 预后 危险因素 回归分析 

分 类 号：R197.323[医药卫生—卫生事业管理]