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目的探讨老年精神科患者医院感染危险因素及病原菌分布情况,为临床预防、管理和控制医院感染提供依据。方法采用回顾性调查方法,对2015年1-12月医院老年精神科收治的5 026例患者的临床资料进行分析,统计患者医院感染的感染率、感染部位、基础精神疾病病种及细菌培养结果,通过对患者的性别、年龄、住院时间、合并躯体疾病的数量、生活自理能力、药物不良反应等因素的分析,探析引发老年精神科患者医院感染的危险因素,并提出预防措施。结果 5 026例患者中医院感染251例,感染率4.99%;感染部位以呼吸道为主,占53.39%;主要基础精神疾病为阿尔采末氏病性痴呆、精神分裂症,分别占35.06%、31.47%;年龄≥80岁和<80岁的感染率分别为10.89%和3.08%、住院时间≥30d和<30d的感染率分别为7.50%和1.48%、合并躯体疾病数量≥3种和<3种的感染率分别为8.53%和1.37%、生活是否完全不能自理的感染率分别为8.78%和2.36%、有无药物不良反应的感染率分别为7.77%和1.77%,差异均有统计学意义(P<0.05);共分离出病原菌213株,其中革兰阴性菌135株占63.38%,以肺炎克雷伯菌、大肠埃希菌为主,分别占24.88%和14.55%;革兰阳性菌73株占34.27%,以金黄色葡萄球菌为主,占10.33%;真菌5株占2.35%,以热带假丝酵母菌及白假丝酵母菌为主,分别占1.41%和0.94%。结论高龄、住院时间过长、合并多种躯体疾病、生活完全不能自理、有药物不良反应是老年精神科患者医院感染的危险因素,病原菌以革兰阴性菌为主,采取针对性的预防措施有利于减少医院感染。
Objective To investigate the risk factors of nosocomial infection and the distribution of pathogens in elderly psychiatric patients and to provide evidence for clinical prevention, management and control of nosocomial infections. Methods A retrospective survey was conducted to analyze the clinical data of 5 026 patients admitted to the elderly psychiatry department from January to December in 2015. The prevalence of nosocomial infections, the infection site, the underlying mental illness and the results of bacterial culture Through analysis of factors such as gender, age, length of hospital stay, number of combined physical illness, self-care ability and adverse drug reaction, the risk factors of nosocomial infection in elderly psychiatric patients were analyzed and preventive measures were proposed. Results The infection rate was 4.99% in 251 cases hospitalized in 5 026 patients. The main infection was respiratory tract, accounting for 53.39%. The main underlying mental illness was Alzheimer’s disease dementia and schizophrenia, accounting for 35.06% and 31.47%, respectively %. The infection rates of patients aged 80 and 80 years were 10.89% and 3.08% respectively, and the infection rates of hospitalization ≥30d and <30d were 7.50% and 1.48%, respectively. The number of combined physical diseases ≥3 and <3 Were 8.53% and 1.37% respectively, and the infection rate of whether life was completely unable to take care of them was 8.78% and 2.36% respectively. The infection rates of adverse drug reactions with and without drugs were 7.77% and 1.77% respectively, with statistical significance ( P <0.05). A total of 213 pathogens were isolated, of which 135 strains of Gram-negative bacteria accounted for 63.38%, mainly Klebsiella pneumoniae and Escherichia coli, accounting for 24.88% and 14.55% respectively; Gram-positive bacteria 73 Strain accounted for 34.27%, mainly Staphylococcus aureus, accounting for 10.33%; 5 strains of fungi accounted for 2.35%, of Candida tropicalis and Candida albicans, accounting for 1.41% and 0.94%. Conclusions Elderly patients, hospitalization for a long time, combined with a variety of physical diseases, life can not take care of themselves, with adverse drug reactions in elderly psychiatric patients with nosocomial infection risk factors, gram-negative pathogens mainly to take targeted preventive measures Help to reduce nosocomial infections.