摘要
目的分析感染性心内膜炎(Infective endocarditis,IE)患者医院感染病原学及其危险因素。方法选取2014年12月-2017年12月于医院接受治疗的IE患者296例,收集患者既往病史、治疗与住院情况、临床资料等,对医院感染影响因素行单因素分析,有统计学意义的行Logistic回归分析,并对感染患者行病原菌分析和药敏检测,分析医院感染者和未感染者的血清C-反应蛋白(C-reactive protein,CRP)、白细胞计数(White blood cell,WBC)、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、淋巴细胞计数(Lymphocyte,LY)、中性粒细胞计数(Neutrophil,NEUT),心功能左心室舒张末径(Left ventricular end diastolic diameter,LVEDD)、左心室缩短分数(Fraction shortening,FS)及左心室射血分数(Left ventricular ejection fraction,LVEF)状况。结果 296例患者发生医院感染有89例,感染率30.07%,分离96株病原菌,其中63株革兰阴性菌,占比65.63%,25株为革兰阳性菌,占比26.04%,8株为真菌,占比8.33%;未感染患者LVEDD、FS及LVEF均低于院内感染组患者(P<0.05);未感染患者血清CRP、WBC、ERS、LY及NEUT含量均低于感染患者(P<0.05);长期住院、使用糖皮质激素、年龄≥60岁、有侵入性操作及有心脏病史为患者医院感染的独立危险因素(P<0.05)。结论医院感染和未感染患者血清指标、心功能间差异比较大,对医院感染患者要紧密观察血清感染指标和心功能变化状况,长期住院、使用糖皮质激素、年龄≥60岁、有侵入性操作及有心脏病史为IE患者医院感染独立危险因素。
OBJECTIVE To analyze the clinical characteristics, etiology and risk factors of nosocomial infection in patients w让h infective endocarditis (IE). METHODS 296 patients with IE who were treated in the hospital from Dec. 2014 to Dec. 2017 were enrolled. The patients, past medical history, treatment and hospitalization, and clinical self-data were collected. The factors affecting nosocomial infection were analyzed by univariate analysis. Logistic regression analysis was performed for the factors with statistical significance, and pathogens and drug susceptibility tests were performed for infected patients. The serum C-reactive protein (CRP), white blood cell (WBC) erythrocyte sedimentation rate (ESR), lymphocyte count (LY), neutrophil count (NEUT), left ventricular end diastolic diameter (LVEDD), left ventricle Fraction shortening (FS) and left ventricular ejection fraction (LVEF) of patients with and without nosocomial infection were analyzed. RESULTS There were 89 cases of nosocomial infection in 296 patients, the infection rate was 30.07%. 96 strains of pathogens were isolated, 63 of them were gram-negative bacteria, accounting for 65.63%, 25 were gram-positive bacteria, accounting for 26.04%, and 8 were fungi, accounting for 8.33%. The LVEDD, FS and LVEF were lower in the uninfected patients than in the nosocomial infection group, and the difference was statistically significant (P<0.05). The levels of serum CRP,WBC, ERS, LY, HGB and NEUT in the uninfected patients were significantly lower than the nosocomial infection group (P <0.05). Long-term hospitalization, use of glucocorticoids, age ≥ 60 years old, invasive procedures, and history of heart disease were independent risk factors for nosocomial infection (P<0.05). CONCLUSION There is a large difference in serum indexes and cardiac function between patients with and without nosocomial infection. The serum infection indexes and cardiac function changes should be closely monitored for patients with nosocomial infection. Long-term hospitalization, use of glucocorticoids, age ≥60 years old, invasive operation and history of heart disease are independent risk factors for nosocomial infection in IE patients.
作者
曾德菲
邢孔玉
邓靖
林静
黄滟
ZENG De-fei;XING Kong-yu;DENG Jing;LIN Jing;HUANG Yan(First Affiliated Hospital of Hainan Medical University , Haikou , Hainan 570102, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第7期1031-1034,共4页
Chinese Journal of Nosocomiology
基金
海南省卫生计生行业科研基金资助项目(1601032061A2001)
关键词
感染性心内膜炎
心功能
病原菌
影响因素
Infective endocarditis
Cardiac function
Pathogens
Risk factors
