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目的分析总结肺结核患者医院感染的临床特征,分析易感因素,为降低肺结核患者医院感染的发生率,提出预防控制措施。方法回顾性分析2005年1月至2013年12月中山大学第五附属医院肺结核患者的资料,观察医院感染发生率、发生部位及病原学分布特点等。结果 1 304例肺结核患者中有79例发生医院感染,感染率6.06%,医院感染部位以下呼吸道最多见,占66.06%。103份送检标本中,共检出病原体89株,检出率为86.41%;其中革兰阴性菌29株(32.58%),革兰阳性菌9株(10.11%),真菌感染51例(57.30%)。单因素χ2检验结果显示,年龄≥60岁及使用其他抗生素是肺结核患者发生医院感染的危险因素(P<0.001)。结论肺结核患者医院感染主要发生于下呼吸道,病原菌以真菌为主,医院感染的发生与高龄、使用其他抗生素有关,需采取综合防治措施降低医院感染发生率。
Objective To analyze and summarize the clinical characteristics of nosocomial infections in patients with pulmonary tuberculosis, analyze the susceptible factors and propose preventive and control measures to reduce the incidence of nosocomial infections in patients with pulmonary tuberculosis. Methods The data of patients with pulmonary tuberculosis in the Fifth Affiliated Hospital of Sun Yat-sen University from January 2005 to December 2013 were retrospectively analyzed. The incidence of nosocomial infection, the location and the distribution of etiology were observed. Results Among 1 304 cases, nosocomial infection occurred in 79 cases of pulmonary tuberculosis, the infection rate was 6.06%. The most common respiratory tract was below the site of infection in the hospital, accounting for 66.06%. Of the 103 samples tested, 89 strains were detected and the detection rate was 86.41%. Among them, 29 (32.58%) were Gram-negative bacteria, 9 (10.11%) were Gram-positive bacteria and 51 %). The univariate χ2 test showed that age ≥60 years and the use of other antibiotics were risk factors for nosocomial infections in patients with pulmonary tuberculosis (P <0.001). Conclusions The most common nosocomial infection in patients with pulmonary tuberculosis occurs in the lower respiratory tract. The main pathogens are fungi. The incidence of nosocomial infections is related to the elderly and the use of other antibiotics. Comprehensive prevention and control measures should be taken to reduce the incidence of nosocomial infections.