摘要
目的探讨老年冠心病合并慢阻肺院内感染影响因素。方法选择2013年3月-2018年3月绍兴市立医院收治的老年冠心病合并慢性阻塞性肺疾病患者491例纳入研究。回顾性调查老年冠心病合并慢性阻塞性肺疾病院内感染发生情况,及院内感染患者病原菌和药敏情况、院内感染相关影响因素,及血清降钙素原(PCT)和C-反应蛋白(CRP)含量变化。结果491例老年冠心病合并慢性阻塞性肺疾病患者发生医院感染83例,感染率为16.90%,以呼吸道感染为主;感染患者共分离出91株病原菌,其中革兰阴性菌58株占63.74%、革兰阳性菌27株占29.67%、真菌6株占6.59%;主要革兰阴性菌中肺炎克雷伯菌对阿米卡星和头孢哌酮耐药性较高,大肠埃希菌对头孢他啶耐药性较高;主要革兰阳性菌中金黄色葡萄球菌对红霉素和青霉素G耐药性较高,表皮葡萄球菌对青霉素G耐药性较高;多因素Logistic回归分析结果显示:住院时间、侵入性操作、合并基础疾病和滥用抗菌药物为影响医院感染的独立危险因素(P<0.05)。结论老年冠心病合并慢性阻塞性肺疾病医院感染以革兰阴性菌为主要病原菌,医院感染危险因素提示需合理应用抗菌药物及做好相关预防手段,降低院内感染发生率。
OBJECTIVE To investigate the risk factors of nosocomial infection in elderly patients with coronary heart disease complicated with chronic obstructive pulmonary disease.METHODS A total of 491 elderly patients with coronary heart disease and chronic obstructive pulmonary infection treated in Shaoxing Municipal Hospital from Mar.2013-Mar.2018 were selected as the research objects.The incidence of nosocomial infection in elderly patients with coronary heart disease and chronic obstructive pulmonary disease,the pathogens and drug sensitivity of patients with nosocomial infection,risk factors of nosocomial infection,and the changes of serum calcitonin(PCT)and C reactive protein(CRP)levels were retrospectively investigated.RESULTS In the 491 cases of elderly patients with coronary heart disease and chronic obstructive pulmonary disease,there were 83 cases of nosocomial infection,with an infection rate of 16.90%.Respiratory infection was the main infection site.91 strains of pathogens were isolated from the infected patients,of which 58 strains of Gram-negative bacteria accounted for 63.74%,27 strains of Gram-positive bacteria accounted for 29.67%and 6 strains of fungi accounted for 6.59%.Among the main Gram-negative bacteria,Klebsiella pneumoniae had relatively high resistance rates to amikacin and cefoperazone,and Escherichia coli had relatively high resistance rate to ceftazidime.Among the main Gram-positive bacteria,Staphylococcus aureus had relatively high resistance rates to erythromycin and penicillin G,and Staphylococcus epidermidis had relatively high resistance rate to penicillin G(75%).Multivariate Logistic regression analysis showed that hospitalization time,invasive operation,combined underlying disease and misuse of antibacterial drugs were independent risk factors for nosocomial infection in the elderly patients with coronary heart disease combined with chronic obstructive pulmonary disease(P<0.05).CONCLUSION The main pathogens of nosocomial infection in elderly coronary heart disease and COPD were Gram-negative bacteria.The risk factors of nosocomial infection suggested that it is necessary to use antibiotics reasonably and take preventive measures,so as to reduce the incidence of infection.
作者
赵梁燕
陶学芳
何文芳
余善招
蔡剑英
ZHAO Liang-yan;TAO Xue-fang;HE Wen-fang;YU Shan-zhao;CAI Jian-ying(Shaoxing Municipal Hospital,Shaoxing,Zhejiang 312000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第15期2275-2279,共5页
Chinese Journal of Nosocomiology
基金
浙江省卫计委科研基金资助项目(2015670238)
关键词
冠心病
慢性阻塞性肺疾病
医院感染
影响因素
Coronary heart disease
Chronic obstructive pulmonary disease
Nosocomial infection
Influencing factors
