论文部分内容阅读
目的分析神经外科医院感染患者的病情、流行病学特征及导致感染发生的危险因素,为神经外科控制医院感染提供临床参考依据。方法回顾性分析2012年1月-2013年7月医院神经外科1 732例住院患者临床资料,对医院感染发生率及感染部位、医院感染病原菌分布和药敏试验等进行分析,同时对神经外科医院感染的危险因素进行统计处理,对单因素进行χ2检验,多因素进行logistic回归分析,筛选出导致患者发生医院感染的危险因素。结果 1 732例住院患者中发生医院感染157例,感染率9.1%;感染部位以下呼吸道为主占41.4%;年龄、住院天数、手术类型等是诱发神经外科患者医院感染的危险因素(P<0.05),经logistic回归分析,年龄、手术类型、开颅手术为独立危险因素(P<0.01);157例患者标本培养中共分离出病原菌172株,其中革兰阴性菌119株占69.2%,革兰阳性菌31株占18.0%,真菌22株占12.8%;鲍氏不动杆菌和大肠埃希菌对氨苄西林耐药率均为100.0%,肺炎克雷伯菌和大肠埃希菌对环丙沙星的耐药率均为100.0%,鲍氏不动杆菌和大肠埃希菌对亚胺培南的耐药率为0。结论神经外科患者易发生医院感染,临床中应重点关注年龄、住院天数、手术类型、留置尿管、开颅手术等神经外科医院感染发生的危险因素,分析患者病原菌,根据药敏试验结果针对性的合理应用抗菌药物,努力降低神经外科医院感染发生率。
Objective To analyze the condition, epidemiological characteristics and the risk factors of nosocomial infections in neurosurgical patients, and provide the clinical reference for neurosurgical control of nosocomial infections. Methods The clinical data of 1 732 hospitalized patients in neurosurgery from January 2012 to July 2013 were retrospectively analyzed. The incidence of nosocomial infections, the distribution of nosocomial infections and susceptibility testing were analyzed. At the same time, the neurosurgical hospital The risk factors of infection were statistically analyzed, the χ2 test was performed on the single factor, and multiple factors were analyzed by logistic regression to screen out the risk factors of nosocomial infection. Results Among the 732 hospitalized patients, 157 cases of nosocomial infections were found, the infection rate was 9.1%, and the respiratory tract was the main infection area (41.4%). The age, days of hospitalization and operation type were the risk factors of nosocomial infection in neurosurgical patients (P <0.05 ), Logistic regression analysis, age, type of surgery and craniotomy were independent risk factors (P <0.01) .A total of 172 pathogenic bacteria were isolated from 157 patients, of which 119 were Gram-negative bacteria accounting for 69.2% 31 strains of positive bacteria accounted for 18.0%, 22 strains of fungi accounted for 12.8%; Acinetobacter baumannii and Escherichia coli were 100.0% resistant to ampicillin, Klebsiella pneumoniae and Escherichia coli on ciprofloxacin The resistance rates of the star were 100.0%, and Acinetobacter baumannii and Escherichia coli were resistant to imipenem. Conclusion Neurosurgical patients are prone to nosocomial infection. In clinic, the risk factors such as age, days of hospitalization, type of surgery, indwelling catheter, craniotomy and other neurosurgical nosocomial infections should be emphasized. Pathogenic bacteria should be analyzed according to the results of drug susceptibility test The rational use of antimicrobial agents, efforts to reduce the incidence of neurosurgical nosocomial infections.