135例重症乙型肝炎医院感染病原学及危险因素  

Etiological characteristics and risk factors for nosocomial infection in 135 patients with severe hepatitis B

作　　者：吴桂香 陈仁芳 周学士 张海燕 徐闻清 WU Gui-xiang;CHEN Ren-fang;ZHOU Xue-shi;ZHANG Hai-yan;XU Wen-qing(WuriFifthPeople'sHospital,Wuri,Jiangsu 21400l,China)

机构地区：[1]无锡市第五人民医院护理部,江苏无锡214001 [2]无锡市第五人民医院感染科,江苏无锡214001 [3]无锡市第五人民医院重症感染科,江苏无锡214001 [4]无锡市第五人民医院重症肝炎科,江苏无锡214001

出　　处：《中华医院感染学杂志》2022年第14期2108-2111,共4页Chinese Journal of Nosocomiology

基　　金：国家“十三五”传染病重大科技专项基金资助项目(2018ZX10721102)。

摘　　要：目的探讨重症乙型肝炎医院感染病原学及危险因素。方法选择2016年2月-2020年12月无锡市第五人民医院收治的135例重症乙型肝炎患者为研究对象,收集医院感染患者临床资料,对感染患者进行病原菌鉴定及耐药性分析,分析重症肝炎患者医院感染的危险因素。结果重症乙型肝炎患者医院感染率为18.52%(25/135),以腹腔、呼吸道、尿路感染多见。检出25株菌株,革兰阴性菌13株(52.00%)、革兰阳性菌8株(32.00%)、真菌4株(16.00%);大肠埃希菌、铜绿假单胞菌对哌拉西林、氨苄西林、头孢唑林、头孢噻肟、头孢曲松、庆大霉素等耐药性较高,对美罗培南、亚胺培南耐药性较低;金黄色葡萄球菌对青霉素、红霉素、克林霉素、左氧氟沙星耐药性较高,未检出万古霉素耐药菌。年龄≥60岁、合并糖尿病、住院天数≥15 d、白蛋白<35 g/L、有侵入性操作是重症肝炎患者医院感染的危险因素(P<0.05)。结论重症肝炎患者医院感染发生率较高,多种因素与之相关。OBJECTIVE To explore the etiological characteristics and risk factors for nosocomial infection in patients with severe hepatitis. METHODS A total of 135 patients with severe hepatitis B who were treated in Wuxi Fifth People’s Hospital from Feb 2016 to Dec 2020 were recruited as the study subjects. The clinical data were collected from the patients with nosocomial infection, the pathogens isolated from the patients with infection were identified, the drug resistance was observed, and the risk factors for the nosocomial infection were analyzed. RESULTS The incidence of nosocomial infection was 18.52%(25/135)among the patients with severe hepatitis B, and the patients with abdominal infection, respiratory tract infection and urinary tract infection were dominant. Totally 25 strains of pathogens were isolated, 13(52.00%) of which were gram-negative bacteria, 8(32.00%) were gram-positive bacteria, and 4(16.00%) were fungi. Escherichia coli and Pseudomonad aeruginosa strains were highly resistant to piperacillin, ampicillin, cefazolin, cefotaxime, ceftriaxone and gentamicin, while the drug resistance rates to imipenem and meropenem were low. Staphylococcus aureus strains were highly resistant to penicillin, erythromycin, clindamycin and levofloxacin, and no vancomycin-resistant strains were detected. The no less than 60 years of age, complication with diabetes mellitus, length of hospital stay no less than 15 days, albumin less than 35 g/L and invasive operation were the risk factors for nosocomial infection in the patients with severe hepatitis(P<0.05). CONCLUSION The incidence of nosocomial infection is high among the patients with severe hepatitis, which is associated with multiple factors.

关 键 词：重症肝炎 乙型肝炎 医院感染 病原菌 危险因素 

分 类 号：R512.6[医药卫生—内科学]