慢性阻塞性肺疾病患者医院感染的危险因素

Risk factors for healthcare-associated infection in patients with chronic obstructive pulmonary disease

摘要:

目的 探讨慢性阻塞性肺疾病（以下简称慢阻肺）住院患者发生医院感染的危险因素及防控措施。方法 回顾性分析2014年7月1日-2017年6月30日某三级医院呼吸内科病区的慢阻肺住院患者医院感染情况，对发生医院感染的病例1：1配对非感染病例，采用单因素卡方检验和多因素logistic回归分析危险因素。结果 共调查1 499例慢阻肺患者，发生医院感染118例，且均找到匹配病例，医院感染率为7.87%；例次感染率为8.27%。单因素分析结果显示，近期住过重症监护病房（ICU）、肺功能分级重或极重度、恶性肿瘤、合并其他肺部疾病、留置导尿管、留置中心静脉导管、抗菌药物使用时间>14 d，抗菌药物使用种类>2种、无创通气及低蛋白血症10种因素是慢阻肺患者发生医院感染的危险因素，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，影响慢阻肺患者发生医院感染的独立危险因素有6种：肺功能分级、恶性肿瘤、合并其他肺部疾病、抗菌药物使用种类>2种、低蛋白血症、无创通气。结论 医务人员应合理应用抗菌药物，积极治疗合并症，加强营养支持，重视肺功能的评估，掌握无创呼吸机的最佳脱机时间并做好消毒工作，以减少慢阻肺患者医院感染的发生。

Abstract:

Objective To explore risk factors and prevention and control measures of healthcare-associated infection(HAI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis on HAI in hospitalized patients with COPD in department of respiratory medicine of a tertiary hospital from July 1, 2014 to June 30, 2017 was conducted, 1:1 HAI case and non-infectious case was matched, risk factors were analyzed by univariate chi-square test and multivariate logistic regression analysis. Results A total of 1 499 COPD patients were investigated, 118 cases of HAI occurred, and all matched cases were found, HAI rate and HAI case rate were 7.87% and 8.27% respectively. Univariate analysis showed that risk factors for HAI in COPD patients were recent stay in intensive care unit(ICU), severe or extremely severe pulmonary function grading, malignant tumor, combined with other pulmonary diseases, indwelling urinary catheter, indwelling central venous catheter, antimicrobial use time>14 days, antimicrobial use>2 kinds, non-invasive ventilation, and hypoproteinemia, diffe-rences were all statistically significant (all P<0.05). Multivariate logistic analysis showed that there were 6 independent risk factors for HAI in COPD patients:pulmonary function grading, malignant tumor, combined with other pulmonary diseases, antimicrobial use>2 kinds, hypoproteinemia, and non-invasive ventilation. Conclusion Health care workers should rationally use antimicrobial agents, actively treat complications, strengthen nutritional support, pay attention to the evaluation of pulmonary function, master the best weaning time of non-invasive ventilator and implement disinfection, so as to reduce the incidence of HAI in COPD patients.