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目的:探究慢性心力衰竭(CHF)患者医院感染的现状、病原菌分布及耐药情况,分析CHF患者发生医院内感染的危险因素。方法:选择2012年9月~2015年9月中心医院及开发区分院收治的390例CHF患者为研究对象,根据CHF患者是否发生医院内感染将其分为观察组(感染患者41例)和对照组(未感染患者349例);收集患者基线资料,对观察组患者进行病原菌培养及药敏实验,分析CHF患者发生医院内感染的危险因素。结果:CHF患者中医院感染的发生率为10.51%(41/390),感染部位以呼吸道19例(46.34%)和泌尿道12(29.27%)为主;前三位的病原菌为铜绿假单胞菌14株(29.79%)、大肠埃希菌11株(23.40%)和肺炎克雷伯菌8株(17.02%);铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌对头孢哌酮、美罗培南及亚胺培南均具有药物敏感性;年龄≥60岁(OR=2.26,P<0.05)、住院时间≥2两个月(OR=5.12,P<0.05)、有侵袭性操作(OR=7.45,P<0.05)、病程长(OR=4.36,P<0.05)是CHF患者发生医院内感染的危险因素。结论:CHF患者医院感染的发生率较高,年龄≥60岁、住院时间≥2个月、侵袭性操作及病程>5年是CHF患者发生医院内感染的危险因素;应当针对患者医院感染特点及药敏实验结果,采取针对性的预防措施和对策,有效控制及降低医院感染的发生。
Objective: To investigate the status of nosocomial infection, the distribution of pathogens and drug resistance in patients with chronic heart failure (CHF) and to analyze the risk factors of nosocomial infection in CHF patients. METHODS: A total of 390 patients with CHF admitted to Central Hospital and Development Zone from September 2012 to September 2015 were selected as study subjects. According to whether hospital-acquired infection occurred in CHF patients, the patients were divided into observation group (41 cases with infection) and The control group (349 cases without infection). The baseline data of patients were collected. The pathogen culture and drug susceptibility test were conducted in the observation group. The risk factors of nosocomial infection in CHF patients were analyzed. Results: The prevalence rate of hospital infection was 10.51% (41/390) in CHF patients, 19 (46.34%) were respiratory tract and 12 (29.27%) were urinary tract infections. The pathogenic bacteria in the top three were Pseudomonas aeruginosa 14 strains (29.79%), 11 strains (23.40%) of Escherichia coli and 8 strains (17.02%) of Klebsiella pneumoniae were positive for Pseudomonas aeruginosa, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Ketamine, meropenem and imipenem were both drug sensitive; patients aged ≥60 years (OR = 2.26, P <0.05), hospital stay ≥2 months (OR = 5.12, P <0.05) (OR = 7.45, P <0.05). The long duration of disease (OR = 4.36, P <0.05) was a risk factor for nosocomial infections in CHF patients. Conclusions: The incidence of nosocomial infections in CHF patients is high, age≥60 years, hospitalization time≥2 months, aggressive operation and duration> 5 years are the risk factors for nosocomial infections in CHF patients. Drug susceptibility test results, to take targeted preventive measures and countermeasures to effectively control and reduce the incidence of nosocomial infections.