重型病毒性肝炎医院感染的危险因素

Risk factors for healthcareassociated infection in patients with severe viral hepatitis

摘要:

目的探讨重型病毒性肝炎患者医院感染的临床特点及其危险因素，为临床预防治疗医院感染提供依据。方法回顾性调查2012年1月—2015年11月收治的193例重型病毒性肝炎患者临床资料，分析发生医院感染患者的临床特征及危险因素，并进行统计分析。结果193例重型病毒性肝炎患者中发生医院感染75例、112例次，感染发病率为38.86%、例次发病率为58.03%。感染部位以腹腔、下呼吸道及胃肠道为主，分别占33.93%、25.00%及16.96%。检出病原菌58株，其中真菌占53.45%，革兰阴性菌占36.21%，革兰阳性菌占10.34%。多因素logistic回归分析结果显示，基础性疾病、应用糖皮质激素、侵入性操作、血白细胞＜4.0×109/L均为重型病毒性肝炎医院感染的独立危险因素（P＜0.05）。结论重型病毒性肝炎患者医院感染发病率高，其危险因素多样。在治疗过程中应有针对性地采取有效预防措施，以降低医院感染发病率。

Abstract:

ObjectiveTo explore the clinical characteristics and risk factors of healthcareassociated infection(HAI) in patients with severe viral hepatitis, so as to provide basis for clinical prevention and treatment of HAI. MethodsClinical data of 193 patients with severe viral hepatitis and admitted to a hospital from January 2012 to November 2015 were analyzed retrospectively, clinical characteristics and risk factors for HAI in patients were evaluated, all data were statistically analyzed. ResultsAmong 193 patients, 75 developed 112 times of HAI, incidence and case incidence of HAI were 38.86% and 58.03% respectively. The main infection sites were abdominal cavity, lower respiratory tract, and gastrointestinal tract, infection rates were 33.93%, 25.00% and 16.96% respectively. A total of 58 strains of pathogens were isolated, including fungi, gramnegative bacteria, and grampositive bacteria, accounting for 53.45%, 36.21%, and 10.34% respectively. Mulvariate logistic regression analysis showed that underlying diseases, use of glucocorticoid, invasive procedure, and white blood cell count＜4.0×109/L were independent risk factors for HAI in patients with severe viral hepatitis (P<0.05). ConclusionIncidence of HAI in patients with severe viral hepatitis is high, risk factors are multiple. It is necessary to take targeted prevention measures during the treatment, so as to reduce the incidence of HAI.