住院患者临床用药与医院感染发生风险的相关性及剂量-反应分析  

The association between clinical drug utilization and the risk of nosocomial infections among inpatients:a comprehensive dose-response analysis

作　　者：张小亮 李芳斌 袁小龙 冯玉娟 王海默 林小勇 魏兵鹏 王蕾 张浩军 ZHANG Xiaoliang;LI Fangbin;YUAN Xiaolong;FENG Yujuan;WANG Haimo;LIN Xiaoyong;WEI Bingpeng;WANG Lei;ZHANG Haojun(Department of Public Health and Hospital Infection Management,the Second People’s Hospital of Gansu Provincial,Lanzhou 730000,China)

机构地区：[1]甘肃省第二人民医院公共卫生与医院感染管理科,兰州730000 [2]甘肃省第二人民医院消化内镜室,兰州730000 [3]甘肃省第二人民医院院长办公室,兰州730000

出　　处：《中国感染与化疗杂志》2025年第2期121-126,共6页Chinese Journal of Infection and Chemotherapy

基　　金：甘肃卫生行业科研计划项目(GSWSKY2023-16)。

摘　　要：目的 分析住院患者临床用药与发生医院感染间的关系,为医院感染预防与控制提供借鉴。方法 采用回顾性病例-对照研究,选择某三甲医院2023年1-12月上报的209例医院感染病例为病例组,对照组采用分层抽样,分层依据为查尔森合并症指数,在同期未发生医院感染的病例中获得,共209例对照病例。结果 单因素分析结果显示质子泵抑制剂、抗酸剂、免疫抑制剂以及抗菌药物联合用药在医院感染发生前使用增加医院感染发生风险(P<0.05)。进一步多因素log-binomial回归分析显示,质子泵抑制剂、免疫抑制剂、抗菌药物联合用药与医院感染发生存在相关性,其相对危险度(RR)分别为1.31(95%CI:1.07~1.60)、1.40(95%CI:1.02~1.91)、1.66(95%CI:1.01~2.74)。基于多因素分析结果,进一步分析两组这三类药物用药时间情况,其中质子泵抑制剂与抗菌药物联合用药病例组用药时间要长于对照组(Z=-6.331,P<0.001;Z=-2.667,P=0.008)。以上三类药物的趋势卡方检验结果显示存在剂量-反应关系(χ^(2)=73.869,P<0.001;χ^(2)=16.530,P<0.001;χ^(2)=35.107,P<0.001)。结论 住院患者使用免疫抑制剂、质子泵抑制剂以及抗菌药物联合用药均易增加医院感染发生的风险,并且随着用药时间的延长,医院感染发生的风险随之增加。Objective To analyze the relationship between clinical drug utilization and the risk of nosocomial infections among hospitalized patients,and provide evidence for the prevention and control of nosocomial infections.Methods This study adopted a retrospective case-control design.The case group included 209 patients with nosocomial infection reported from January 2023 to December 2023 in a tertiary hospital.The control group included 209 patients without nosocomial infection during the same period.The patients in the control group were selected by stratified sampling based on Charlson Comorbidity Index(CCI).Results Univariate analysis showed that proton pump inhibitors,antacids,immunosuppressants and prior antimicrobial combination therapy increased the risk of nosocomial infection(P<0.05).Multivariate log-binomial regression analysis showed that proton pump inhibitors,immunosuppressive drugs,and prior antimicrobial combination therapy were correlated with nosocomial infection.The corresponding relative risk(RR)was 1.31(95%CI:1.07-1.60),1.40(95%CI:1.02-1.91),and 1.66(95%CI:1.01-2.74),respectively.Further analysis indicated that the patients with nosocomial infection had longer time in use of proton pump inhibitors and prior antimicrobial combination therapy than the patients in the control group(Z=-6.331,P<0.001;Z=-2.667,P=0.008).The trend Chi-square test showed that there was a dose-response relationship for proton pump inhibitors 22(χ^(2)=73.869,P<0.001),immunosuppressive drugs(χ^(2)=16.530,2 P<0.001),and prior antimicrobial combination therapy(χ^(2)=35.107,P<0.001).Conclusions The use of immunosuppressants,proton pump inhibitors and antimicrobial combination therapy increases the risk of nosocomial infections in hospitalized patients.The prolonged use of these drugs will further increase the risk of nosocomial infection.

关 键 词：医院感染 质子泵抑制剂 免疫抑制剂 抗菌药物 

分 类 号：R969.3[医药卫生—药理学] R197.323[医药卫生—药学]