糖尿病患者院内多重耐药菌感染易感因素分析

卢健聪　夏晓英

[摘要] 目的 探讨糖尿病患者院内多重耐药菌感染，为临床防治提供科学依据。 方法 选取惠州市中心人民医院2008年1月～2012年12月糖尿病患者发生院内感染的264例进行回顾性分析，以符合多重耐药感染的120例作为病例组，非多重耐药感染的144例作为对照组， 所有病例均记录以下项目： 一般情况、糖尿病病程、基础疾病、糖化血红蛋白、空腹血糖、餐后2h血糖、并发症、侵入性操作、免疫功能、抗生素的使用、感染后的预后。全部数据输入电脑，采用统计软件SPSS17.0进行汇总分析。 结果 5年来糖尿病患者院内感染、院内多重耐药菌的发病率逐年上升，以多重耐药感染上升的速度最快。以呼吸道感染最多，最常见的病原菌为革兰阴性菌（54.8%，136/248）。年龄、住院时间、ICU病房、空腹血糖、餐后2h血糖、糖化血红蛋白、昏迷、感染前30d使用抗生素、联用抗生素是多重耐药感染的易感因素。感染后30d内的死亡率高于对照组（P<0.05）。 结论 糖尿病患者院内多重耐药菌的感染十分严重，与多种因素有关，预后不良，应针对易感因素采取综合性的防治措施。

[关键词] 糖尿病；院内感染；多重耐药；易感因素

[中图分类号] R197.3 [文献标识码] A [文章编号] 2095-0616（2014）13-09-04

[Abstract] Objective To explore hospital-acquired infections with multiple drug-resistant bacteria for patients with diabetes，and provide scientific evidence for clinical prevention and treatment. Methods 264 patients with diabetes who had hospital-acquired infections in Huizhou Municipal Central Hospital from January 2008 to December 2012 were selected and analyzed retrospectively.120 patients who accorded with multiple drug-resistant infections were allocated to an experimental group，and 144 patients without multiple drug-resistant infections were allocated to a control group.Following items were recorded in all patients：general conditions，courses of diabetes，underlying diseases，glycosylated hemoglobin， fasting blood glucose，2-hour postprandial blood glucose，complications，invasive procedure，immune function， use of antibiotics，and prognosis of infections.All data were recorded in computers，and a pooled analysis was carried out via statistical software SPSS 17.0. Results Incidence of hospital-acquired infections with multiple drug-resistant bacteria for patients with diabetes increased year by year in recent five years.Incidence of multiple drug-resistant infections increased in the fastest fashion. The most commonly seen one was respiratory tract infection，and the most commonly seen pathogen was gram-negative bacteria（54.8%，136/248）.Predisposing factors of multiple drug-resistant infections included age，hospitalization time，ICU wards，fasting blood sugar，2-hour postprandial blood sugar， glycosylated hemoglobin，coma，use of antibiotics 30 days before infections，and combined use of antibiotics. Mortality rate in 30 days after infections was higher than that in the control group（P<0.05）. Conclusion Hospital-acquired infections with multiple drug-resistant bacteria for patients with diabetes is severe， multifactor and poor in prognosis，and therefore comprehensive prevention measures should be taken on the basis of predisposing factors.endprint

[Key words] Diabetes；Hospital-acquired infection；Multiple drug-resistance；Predisposing factors

感染是糖尿病患者的第二死亡原因，文献报道约10%糖尿病患者死于感染[1]，近年来随着广谱抗生素的广泛使用，糖尿病院内感染的发病率逐渐升高，罹患严重的感染特别是多重耐药菌的感染逐渐增多，而且一旦发生多重耐药感染，病死率高达50%以上[2]。如何防治这类院内感染已经成为一个临床难题。为探寻降低院内感染发病率的途径，本研究回顾性分析了我院近5年来糖尿病院内多重耐药感染的各种相关因素，现报道如下。……