《中国康复理论与实践》

中国康复理论与实践 >

2019 , Vol. 25 >Issue 6: 664 - 669

DOI: https://doi.org/10.3969/j.issn.1006-9771.2019.06.009

专题

脊髓损伤患者医院感染的临床特点及危险因素分析

  • 刘慧珍 ,
  • 赵国伟 ,
  • 李培兰 ,
  • 商娜 ,
  • 王娜 ,
  • 刘芦姗
展开
  • 1.首都医科大学康复医学院;北京市 100068;
    2.中国康复研究中心北京博爱医院,a急诊科;b药剂科,北京市 100068
刘慧珍(1983-)，女，汉族，山东诸城市人，硕士，主治医师，主要研究方向：急诊医学临床与研究。

收稿日期: 2018-12-27

  修回日期: 2019-01-15

  网络出版日期: 2019-06-25

收起

Clinical Characteristics and Risk Factors of Nosocomial Infection in Patients with Spinal Cord Injury

  • LIU Hui-zhen ,
  • ZHAO Guo-wei ,
  • LI Pei-lan ,
  • SHANG Na ,
  • WANG Na ,
  • LIU Lu-shan
Expand
  • 1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China;
    2.a.Department of Emergency; b. Department of Pharmacy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received date: 2018-12-27

  Revised date: 2019-01-15

  Online published: 2019-06-25

Fold

摘要

目的 探讨脊髓损伤患者医院感染的发生部位、病原菌特点及危险因素。方法 回顾性调查2015年1月至2017年6月期间526例脊髓损伤住院患者的临床资料，总结医院感染病原菌的分布情况及菌株耐药性特点；对医院感染的危险因素进行分析。结果 共有159例次发生医院感染，感染的主要部位为泌尿道(60.4%)和下呼吸道(28.9%)。主要致病菌是大肠埃希菌(39.0%)、铜绿假单胞菌(15.7%)、肺炎克雷伯杆菌(11.3%)和奇异变形杆菌(9.4%)；致病菌对二、三代头孢菌素和喹诺酮类抗生素中高度耐药，而对含β-内酰胺酶抑制剂的复方制剂、碳青霉烯类和氨基糖苷类抗生素较敏感；住院时间、脊髓损伤程度、侵入性操作、营养风险、抗菌药物联合使用是发生医院感染的相关危险因素(P < 0.05)。结论 脊髓损伤患者医院感染的部位多为泌尿道和呼吸道；致病菌以革兰阴性杆菌为主，常呈多重耐药；临床应针对医院感染的危险因素进行相应干预，以提高患者的生活质量。

关键词： 脊髓损伤; 医院感染; 病原菌; 危险因素

本文引用格式

刘慧珍 , 赵国伟 , 李培兰 , 商娜 , 王娜 , 刘芦姗 . 脊髓损伤患者医院感染的临床特点及危险因素分析[J]. 中国康复理论与实践, 2019 , 25(6) : 664 -669 . DOI: 10.3969/j.issn.1006-9771.2019.06.009

Abstract

Objective To explore the characteristics of nosocomial infection in patients with spinal cord injury, and analyze the risk factors.Methods From January, 2015 to June, 2017, 526 patients with spinal cord injury in our hospital were reviewed. The distribution of pathogens and the characteristics of drug resistance of strains were summarized, and the risk factors of nosocomial infection were analyzed.Results There were 159 person-times with nosocomial infection, and most of the infections were found in urinary tract (60.4%) and lower in respiratory tract (28.9%). The main pathogenic germs were Escherichia coli (39.0%), Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (11.3%) and Proteus mirabilis (9.4%). The main pathogens were resistant to second or third generation of cephalosporins and quinolones moderately or severely, but sensitive to compound preparations containing beta-lactamase inhibitors, carbapenems and aminoglycosides. The risk factors for the nosocomial infections in the spinal cord injury patients included the hospitalization time, severity of spinal cord injury, invasive operation history, nutritional risk and use of antibiotics (P < 0.05).Conclusion Most of the nosocomial infections in patients with spinal cord injury are in urinary tract and respiratory tract. Gram-negative bacilli are the main pathogenic bacteria, which often show multiple drug resistance. It is necessary to take targeted interventions according to the risk factors of nosocomial infections in order to improve the quality of life of patients.

Key words： spinal cord injury; nosocomial infection; pathogens; risk factors

参考文献

1 EvansC T, LaVelaS L, WeaverF M, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder [J]. Infect Control Hosp Epidemiol, 2008, 29(3): 234-242.
2 LaVelaS L, EvansC T, MiskevicsS, et al. Long-term outcomes from nosocomial infections in persons with spinal cord injuries and disorders [J]. Am J Infect Control, 2007, 35(6): 393-400.
3 PannekJ. Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice. A questionnaire-based survey and review of the literature [J]. Spinal Cord Med, 2011, 34(1): 11-15.
4 LalwaniS, PuniaP, MathurP, et al. Hospital acquired infections: preventable cause of mortality in spinal cord injury patients [J]. J Lab Physicians, 2014, 6(1): 36-39.
5 RobertsT T, LeonardG R, CepelaD J. Classifications in Brief: American Spinal Injury Association (ASIA) Impairment Scale [J]. Clin Orthop Relat Res, 2017, 475(5): 1499-1504.
6 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 85(5): 314-320.
7 吕倩,王伟,姚颖,等. 老年营养风险病人易发生医院感染[J]. 临床研究, 2017, 31(1): 33-35.
8 KondrupJ, RasmussenH H, HambergO, et al. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321-336.
9 赵国伟,高钧. 脊髓损伤后泌尿系感染的菌群分布及耐药特征[J]. 中国康复理论与实践, 2016, 22(5): 590-592.
10 胡忠春,赵明,张文. 泌尿外科患者医院感染病原菌分布与感染危险因素分析[J]. 中华医院感染学杂志, 2015, 25(1): 199-201.
11 KhorvashF, MostafavizadehK, MobasherizadehS, et al. Susceptibility pattern of E. coli-associated urinary tract infection (UTI): a comparison of spinal cord injury-related and nosocomial UTI [J]. Med Sci Monit, 2009, 15(11): CR579-CR582.
12 GirardR, MazoyerM A, PlauchuM M, et al. High prevalence of nosocomial infections in rehabilitation units accounted for by urinary tract infections in patients with spinal cord injury [J]. J Hosp Infect, 2006, 62(4): 473-479.
13 李琳琳,郝世杰,王万宏,等. 脊髓损伤后神经源性膀胱康复治疗的研究进展[J]. 社区医学杂志, 2018, 16(11): 88-90.
14 SulisC A, WalkeyA J, AbadiY, et al. Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long term acute care hospital setting [J]. Am J Infect Control, 2014, 42(5): 536-538.
15 JohnsonK G, HillL J. Pulmonary management of the acute cervical spinal cord injured patients [J]. Nuts Clin North Am, 2014, 49(3): 357-369.
16 Garnacho-MonteroJ, Corcia-PalomoY, Amaya-VillarR, et al. How to treat VAP due to MDR pathogens in ICU patients [J]. BMC Infect Dis, 2014, 135(14): 1-7.
17 BerneyS, BraggeP, GrangerC, et al. The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review [J]. Spinal Cord, 2011, 49(1): 17-29.
18 周淑清,王平分,张海清,等. 脊髓损伤患者医院感染的临床调查与分析[J]. 中国康复理论与实践, 2005, 11(10): 846-847.
19 朱佳琪,马跃文,陈锐. 脊髓损伤患者泌尿系感染研究进展[J]. 中国康复理论与实践, 2016, 22(6): 676-679.
20 SievertD M, RicksP, EdwardsJ R, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010 [J]. Infect Control Hosp Epidemiol, 2013, 34(1): 1-14.
21 陈志林,刘建莉,郑盼盼,等. ICU患者导管相关感染的影响因素及病原学特点研究[J]. 中华医院感染学杂志, 2018, 28(21): 3249-3252.
22 LochsH, AllisonS P, MeierR, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitionsand general topics [J]. Clin Nutr, 2006, 25(2): 180-186.
23 董宏艳,曾源,谢静,等. 80岁以上老年肺炎病人营养风险筛查及营养支持治疗应用分析[J]. 实用老年医学, 2015, 29(5): 415-418.
24 SoguelL, RevellyJ P, SchallerM D, et al. Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intersive care unit dietitian can make the difference [J]. Crit Care Med, 2012, 40(2): 412-419.
25 林乐丹,孙素珍,何乐琼,等. ICU医院感染危险因素及综合护理措施对预后的影响[J]. 中华医院感染学杂志, 2017, 27(12): 2845-2848.
26 吴安华,文细毛,李春辉,等. 2012年全国医院感染现患率与横断面抗菌药物使用率调查报告[J]. 中国感染控制杂志, 2014, 13(1): 8-15.
27 WongS, SantulloP, O'DriscollJ, et al. Use of antibiotic and prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: a UK national spinal injury centre experience [J]. Spinal Cord, 2017, 55(6): 583-587.
28 徐恒忠,王者宁,李金英,等. 以药动学/药效学相关参数为依据优化抗菌药物给药方案[J]. 中国医院药学杂志, 2008, 28(4): 322-324.
29 熊旭东. PK/PD参数与抗菌药物的优化应用[J]. 抗感染学, 2012, 9(1): 11-13.
30 郭宏,尚嘉鹏,龙莉,等. 我院ICU病房主要革兰阴性菌感染情况及抗菌药物治疗方案优化[J]. 中国药房, 2010, 21(18): 1674-1676.
Options
文章导航

/

〈 〉