超声介入治疗的老年患者医院感染病原学及危险因素分析
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摘要
目的研究老年患者超声介入治疗后医院感染的病原菌特征及危险因素分析。方法选取2013年3月-2018年4月在本院行超声介入诊疗的862例老年患者,收集患者标本细菌培养及细菌鉴定,对感染患者的临床资料采用单因素和多因素Logistic回归分析,分析其感染的独立危险因素。结果 862例老年患者超声介入治疗后确诊182例发生感染,发生率为21.11%,其中呼吸道86例,占47.25%,泌尿道78例,占42.86%。182例感染患者共分离出186株病原菌,其中革兰阴性菌108例,占58.06%,革兰阳性菌78株,占41.94%。单因素和进一步Logistic回归分析显示,住院天数≥14 d、BMI≥30 kg/m~2、诊疗季节夏季、无使用抗生素、合并基础疾病和侵入性操作是老年患者超声介入治疗后发生感染的独立危险因素(P<0.05)。结论老年患者超声介入治疗后医院感染以革兰阴性菌导致的呼吸道、泌尿道感染为主,减少住院天数、控制体质量、避免夏季诊疗、预防使用抗生素、治疗基础疾病和避免侵入性操作可以预防感染发生,降低感染的发生率。
Objective To study the characteristics and risk factors of nosocomial infection in elderly patients after ultrasound intervention. Methods A total of 862 elderly patients who underwent ultrasound intervention in our hospital from March 2013 to April 1818 were selected. Bacterial culture and bacterial identification were collected. The clinical data of infected patients were analyzed by univariate and multivariate Logistic regression analysis. And the risk factors for infection were analyzed. Results Nosocomial infection was observed in 182 of 862 elderly patients undergoing ultrasound test, accounting for 21.11%, of which 86 cases were respiratory tract, accounting for 47.25%, 78 cases were urinary tract, accounting for 42.86%. A total of 186 pathogenic bacteria were isolated from 182 infected patients, of which 108 were Gram-negative bacteria, accounting for 58.06%, and 78 were Gram-positive bacteria, accounting for 41.94%. Univariate and further Logistic regression analysis showed that days of hospitalization ≥14 d, BMI≥30 kg/m~2, summer of diagnosis and treatment, no antibiotic use, combined basal disease, and invasive operation were independent risk factors for infections after ultrasound intervention in elderly patients(P<0.05). Conclusion Nosocomial infection after interventional therapy for elderly patients is mainly based on respiratory and urinary tract infections caused by gram-negative bacteria. Reduction of hospitalization days, weight control, prevention of summer treatment, prevention of antibiotic use, treatment of underlying diseases, and avoidance of invasive procedures can prevent the occurs of infections and reduces the incidence of infection.
Objective To study the characteristics and risk factors of nosocomial infection in elderly patients after ultrasound intervention. Methods A total of 862 elderly patients who underwent ultrasound intervention in our hospital from March 2013 to April 1818 were selected. Bacterial culture and bacterial identification were collected. The clinical data of infected patients were analyzed by univariate and multivariate Logistic regression analysis. And the risk factors for infection were analyzed. Results Nosocomial infection was observed in 182 of 862 elderly patients undergoing ultrasound test, accounting for 21.11%, of which 86 cases were respiratory tract, accounting for 47.25%, 78 cases were urinary tract, accounting for 42.86%. A total of 186 pathogenic bacteria were isolated from 182 infected patients, of which 108 were Gram-negative bacteria, accounting for 58.06%, and 78 were Gram-positive bacteria, accounting for 41.94%. Univariate and further Logistic regression analysis showed that days of hospitalization ≥14 d, BMI≥30 kg/m~2, summer of diagnosis and treatment, no antibiotic use, combined basal disease, and invasive operation were independent risk factors for infections after ultrasound intervention in elderly patients(P<0.05). Conclusion Nosocomial infection after interventional therapy for elderly patients is mainly based on respiratory and urinary tract infections caused by gram-negative bacteria. Reduction of hospitalization days, weight control, prevention of summer treatment, prevention of antibiotic use, treatment of underlying diseases, and avoidance of invasive procedures can prevent the occurs of infections and reduces the incidence of infection.
引文
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[13] Bookland MJ, Sukul V, Connolly PJ. Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates[J]. J Neurosurg, 2014, 121(1): 189-194.
[14] Skaff ER, Doucette S, McDiarmid S, et al. Vascular access devices in leukemia: a retrospective review amongst patients treated at the Ottawa Hospital with induction chemotherapy for acute leukemia[J]. Leuk Lymphoma, 2012, 53(6): 1090-1095.
[15] 尤其琴, 顾奇澜. 超声侵入性操作医院感染的调查与控制措施分析[J]. 中国卫生产业, 2016, 13(9): 36-38.
[2] Rosenthal VD, Bijie H, Maki DG, et al. International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009[J]. Am J Infect Control, 2012, 40(5): 396-407.
[3] Aragaki-Nakahodo AA, Guitron-Roig J, Eschenbacher W, et al. Endobronchial ultrasound-guided needle aspiration of a bronchogenic cyst to liberate from mechanical ventilation: case report and literature review[J]. J Bronchology Interv Pulmonol, 2013, 20(2): 152-154.
[4] Derewacz DK, Goodwin CR, McNees CR, et al. Antimicrobial drug resistance affects broad changes in metabolomic phenotype in addition to secondary metabolism[J]. Proc Natl Acad Sci USA, 2013, 110(6): 2336-2341.
[5] 王金凤, 张义彬, 孙伟, 等. 超声介入治疗病人的护理[J]. 齐齐哈尔医学院学报, 2012, 33(23): 3304-3305.
[6] Michailidis L, Williams CM, Bergin SM, et al. Comparison of healing rate in diabetes-related foot ulcers with low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised trial protocol[J]. J Foot Ankle Res, 2014, 7(1): 1.
[7] Degirmenci T, Gunlusoy B, Kozacioglu Z, et al. Utilization of a modified clavien classification system in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard society of interventional radiology practice guidelines[J]. Urology, 2013, 81(6): 1161-1167.
[8] Alberti N, Buy X, Frulio N, et al. Rare complications after lung percutaneous radiofrequency ablation: Incidence, risk factors, prevention and management[J]. Eur J Radiol, 2016, 85(6): 1181-1191.
[9] Zopf Y, Konturek P, Nuernberger A, et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors[J]. Can J Gastroenterol, 2008, 22(12): 987-991.
[10] Ahmed HU, Hindley RG, Dickinson L, et al. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study[J]. Lancet Oncol, 2012, 13(6): 622-632.
[11] Lahmer T, Messer M, Schwerdtfeger C, et al. Invasive mycosis in medical intensive care unit patients with severe alcoholic hepatitis[J]. Mycopathologia, 2014, 177(3/4): 193-197.
[12] Walaszek M. The analysis of the occurrence of nosocomial infections in the neurosurgical ward in the District Hospital from 2003-2012[J]. Przegl Epidemiol, 2015, 69(3): 507-514, 619-523.
[13] Bookland MJ, Sukul V, Connolly PJ. Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates[J]. J Neurosurg, 2014, 121(1): 189-194.
[14] Skaff ER, Doucette S, McDiarmid S, et al. Vascular access devices in leukemia: a retrospective review amongst patients treated at the Ottawa Hospital with induction chemotherapy for acute leukemia[J]. Leuk Lymphoma, 2012, 53(6): 1090-1095.
[15] 尤其琴, 顾奇澜. 超声侵入性操作医院感染的调查与控制措施分析[J]. 中国卫生产业, 2016, 13(9): 36-38.