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目的探讨重症监护病房(ICU)老年患者发生医院感染的危险因素,降低医院感染发生率,以期降低重症监护病房老年患者医院感染发生率,提高医疗质量。方法回顾性分析ICU 1107例老年患者临床资料,1015例未发生医院感染老年患者作为非感染组,发生医院感染的92例老年患者作为感染组;分析感染患者的感染部位、感染危险因素等。结果 1107例老年患者中发生医院感染92例,感染率为8.31%;呼吸系统、泌尿系统、手术切口以及深静脉穿刺部位是ICU老年患者发生医院感染的常见部位;真菌是最为常见的病原菌,其次是肺炎克雷伯菌和大肠埃希菌;经单因素和多因素分析,患者的年龄、手术时间、基础疾病、侵入性操作、使用抗菌药物以及患者的住院时间是患者发生医院感染的危险因素,经多因素分析,OR值(95%CI)分别为:18.274(13.174～30.228)、0.248(0.117～1.432)、13.384(6.472～20.482)、16.172(10.742～26.174)、12.371(6.380～24.085)、0.375(0.017～1.488)。结论 ICU老年患者发生医院感染以呼吸系统感染最为常见,病原菌较为多样,与多种因素相关,要针对容易发生医院感染的关键环节,采取相应的措施,降低感染的发生率,提高医疗质量。
Objective To explore the risk factors of nosocomial infection in elderly patients in intensive care unit (ICU) and reduce the incidence of nosocomial infections in order to reduce the incidence of nosocomial infections and improve the quality of medical care in elderly patients in intensive care unit. Methods The clinical data of 1107 elderly patients in the ICU were retrospectively analyzed. A total of 92 elderly patients with nosocomial infections in 1015 elderly patients without nosocomial infection were selected as the infected group. The infected sites and the risk factors of infection were analyzed. Results Among 1107 elderly patients, 92 cases were nosocomial infection with the infection rate of 8.31%. Respiratory system, urinary system, surgical incision and deep venous puncture were common sites of nosocomial infection in elderly ICU patients. Fungi were the most common pathogenic bacteria, followed by Were Klebsiella pneumoniae and Escherichia coli. According to univariate and multivariate analysis, the age of patients, operation time, underlying diseases, invasive procedures, use of antibacterials and patient’s hospital stay were the risk factors of nosocomial infection . The multivariate analysis showed that OR (95% CI) was 18.274 (13.174-30.228), 0.248 (0.117-1.432), 13.384 (6.472-20.482), 16.172 (10.742-26.174), 12.371 (6.380-24.085) , 0.375 (0.017 ~ 1.488). Conclusions Nosocomial infections in the elderly patients with respiratory infections are the most common, the pathogens are more diverse and related to many factors. To reduce the incidence of infections and improve the quality of care, we should take corresponding measures to prevent the occurrence of nosocomial infections in ICU elderly patients.