摘要
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 explore the risk factors for nosocomial infections in patients of psychogeriatric department and analyze the distribution of pathogens so as to provide guidance for clinical control and prevention of the nosocomial infections.METHODS By means of retrospective survey,the clinical data of 5 026 patients who were treated in the psychogeriatric department from Jan 2015 to Dec 2015 were analyzed.The incidence of nosocomial infections,infection sites,types of underlying mental diseases,and result of bacterial culture were statistically analyzed.The factors such as genders,age,length of hospital stay,number of complication with somatic diseases,self-care ability of daily living,and drug-induced adverse reactions were observed,the risk factors for the nosocomial infections in the patients of psychogeriatric department were explored,and the prevention measures were put forward.RESULTS Of the 5 026 patients,251 had the nosocomial infections,with the infection rate 4.99%,of whom 53.39 % had respiratory tract infections.The Alzheimer＆#39;s disease and schizophrenia were dominant among the underlying mental diseases,accounting for 35.06% and 31.47%,respectively.The incidence rate of nosoeomial infections was 10.89% in the patients aged no less than 80 years old,3.08% in the patients aged less than 80 years old;the infection rate was 7.50% in the patients with the length of hospital stay no less than 30 days,1.48% in the patients with the length of hospital stay less than 30 days;the infection rate was 8.53% in the patients complicated with no less than 3 types of somatic diseases,1.37 % in the patients complicated with less than 3 types of somatic diseases;the infection rate was 8.78% in the patients who were completely unable to take care of themselves about daily life,2.36% in the patients who were not completely unable to take care of themselves about daily life;the infection rate was 7.77% in the patients with drug-induced adverse reactions,1.77% in the patients without the drug-induced adverse reactions,and there was significant difference （P〈0.05）.Totally 213 strains of pathogens were isolated,of which 135 （63.38%） were gram-negative bacteria,73 （34.27%） were gram-positive bacteria,and 5 （2.35%） were fungi;Klebsiella pneumoniae and Escherichia coli were dominant among the gram-negative bacteria,accounting for 24.88 % and 14.55 %,respectively;Staphylococcus aureus was the predominant species of the gram-positive bacteria,accounting for 10.33 %;Candida tropicalis and Candida albicans were dominant among the fungi,accounting for 1.41% and 0.94%,respectively.CONCLUSION The risk factors for the nosocomial infections in the patients of psychogeriatric department include the advanced age,long length of hospital stay,complication with multiple somatic diseases,completely unable to take care of themselves,and drug-induced adverse reactions.The gram-negative bacteria are dominant among the pathogens.It is necessary to take targeted prevention measures so as to reduce the incidence of the nosocomial infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第10期2248-2251,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生一般研究基金资助项目(2011KYA135)
关键词
老年精神科患者
医院感染
危险因素
病原菌
Patient of psychogeriatric department
Nosocomial infection
Risk factor
Pathogen
