摘要
目的研究三种入院方式致老年卒中患者相关性肺炎多药耐药特点,总结干预措施,以期避免交叉感染、提高抗感染治疗效果和医院质量。方法选取2014年1月-2016年1月老年卒中相关性肺炎患者707例,按照入院方法,门诊入院患者373例为门诊入院组,外院转入者74例为外院转入组,院内转入者260例为院内组,比较三组耐药菌阳性率、院内感染和耐药菌种的前四位分布。结果耐药菌阳性率,外院转入组、门诊转入组高于院内组,差异有统计学意义(P<0.05),且外院转入组高于门诊转入组,差异有统计学意义(P<0.05);耐药菌院内感染率,外院转入组、院内组高于门诊转入组,差异有统计学意义(P<0.05),外院转入组与院内组比较,差异无统计学意义;8~15d,三组耐药菌阳性率高于1~7d,≥16d高于8~15d,差异均有统计学意义(P<0.05);外院转入组、院内组鲍曼不动杆菌感染率高于其他耐药菌种,门诊转入组肺炎克雷伯杆菌高于其他耐药菌种,差异均有统计学意义(P<0.05)。结论对于老年卒中相关性肺炎来说,门诊转入、外院转入者多药耐药阳性率最高,尤其是外院转入,而加强此类人群耐药菌种监测、筛查,采取有效隔离、选取适宜抗菌药物等措施能有效避免院内交叉感染、提高治疗效果。
OBJECTIVE To investigate the characteristics of multidrug-resistance included by three admission meth-ods of elderly patients with stroke-related pneumonia and put forward the intervention measures so as to prevent the cross infection and improve the effect of treatment of infection ,as well as the medical quality .METHODS A to-tal of 707 elderly patients with stroke-related pneumonia who were treated from Jan 2014 to Jan 2016 were enrolled in the study .373 patients who were admitted from outpatient department were assigned as the outpatient trans-ferred group ,74 patients who were admitted outside the hospital were assigned as outer hospital transferred group ,and 260 patients who were admitted inside the hospital were set as the inner hospital transferred group . The positive rate of drug-resistant bacteria ,incidence of nosocomial infections ,and distribution of top 4 species of drug-resistant bacteria were observed and compared among the three groups .RESULTS The positive rate of drug resistant bacteria ,outside the hospital into the group ,into the outpatient group was significantly higher than that of the hospital group （P〈0 .05） ,and outside the hospital into the outpatient group was significantly higher than that in group transferred （P〈0 .05）;the rate of nosocomial infections of drug-resistant bacteria ,outside the hos-pital into the hospital outpatient group and the group was significantly higher than that in group transferred （P〈0 .05） ,8~15d ,three groups of drug resistant bacteria positive rate was higher than 1~7d ,16d or higher than 8~15d ,the differences were significant （ P〈 0 .05 ）;outside the hospital into the group and hospital group Acinetobacter bauman infection rate was higher than the others in the group of outpatients antibiotic resistant strains of K lebsiella pneumoniae were higher than the other , the differences were significant （ P 〈 0 .05 ） CONCLUSION Among the elderly patients with stroke-related pneumonia ,the positive rate of the multidrug-resist-ance is the highest in the patients who are transferred from outpatient and outer hospital ,especially those who are transferred from the outer hospital .It is an effective way to strengthen the surveillance and screening of the drug-resistant bacteria in this group of patients ,take effective isolation measures ,and choose appropriate antibiotics so as to prevent the nosocomial cross infections and improve the therapeutic effect .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第6期1267-1270,共4页
Chinese Journal of Nosocomiology
基金
上海市教育委员会专项基金资助项目(Fa1-3903-16-110063)
关键词
老年
卒中
相关性肺炎
入院方法
多药耐药
Elderly
Stroke
Related pneumonia
Admission method
M ultidrug-resistance
