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目的探讨系统性红斑狼疮(SLE)患者发生医院感染的临床特点及影响因素,为预防控制医院感染的发生提供参考。方法采取床旁调查和查阅住院病历相结合的方法,根据2001年卫生部《医院感染诊断标准》,将295例SLE患者是否符合医院感染标准分为医院感染组与对照组进行相关因素分析。结果呼吸道及皮肤黏膜是SLE患者最常见的感染部位,其感染率分别为45.6%和18.4%。最常见细菌感染(57.6%),革兰阴性菌、革兰阳性菌分别占38%和19.6%,其中铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌分别占13.0%、8.7%、5.4%、5.4%;其次为疱疹病毒感染(20.7%);真菌感染占16.3%,其中白色假丝酵母菌占8.7%。使用糖皮质激素治疗后真菌感染率为40.0%,明显高于疱疹病毒及结核感染率,差异有统计学意义(P<0.05);低蛋白血症患者普通细菌感染率为63.3%,明显高于真菌、疱疹病毒和结核感染率,差异有统计学意义(P<0.05);白细胞减少患者结核感染率为9.1%,与其他组的结核感染率比较,差异无统计学意义(P>0.05);从影响医院感染相关因素看,SLE患者住院时间、两个以上器官受损、感染前使用过抗生素治疗、使用糖皮质激素及免疫抑制剂治疗、低蛋白血症和24 h尿蛋白>3.5 g是医院感染的主要危险因素,其感染率明显高于对照组。结论呼吸道及皮肤黏膜是SLE患者最常见的感染部位,医院感染病原体以革兰阴性菌为主,其次为革兰阳性菌。通过缩短住院时间、有效控制病情、谨慎使用糖皮质激素和免疫抑制剂、合理使用抗生素、防止多器官功能损伤等有可能减少SLE患者医院感染的发生。
Objective To investigate the clinical characteristics and influencing factors of nosocomial infection in patients with systemic lupus erythematosus (SLE) and provide references for the prevention and control of nosocomial infections. Methods According to the method of bedside investigation and inpatient medical records, according to the “Diagnostic Criteria of Nosocomial Infections” issued by the Ministry of Public Health in 2001, 295 SLE patients were divided into nosocomial infection criteria and nosocomial infection and control groups. Results Respiratory and skin mucosa were the most common sites of infection in SLE patients, with infection rates of 45.6% and 18.4%, respectively. The most common bacterial infections (57.6%), Gram-negative bacteria, Gram-positive bacteria accounted for 38% and 19.6%, respectively, of which Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Staphylococcus aureus accounted for 13.0%, 8.7%, 5.4% and 5.4% respectively; followed by herpes simplex virus infection (20.7%); fungal infections accounted for 16.3%, of which Candida albicans accounted for 8.7%. The fungal infection rate after glucocorticoid treatment was 40.0%, which was significantly higher than that of herpes simplex virus and tuberculosis, the difference was statistically significant (P <0.05). The prevalence of common bacterial infection in hypoproteinemia patients was 63.3% The infection rates of fungi, herpes virus and tuberculosis were statistically significant (P <0.05). The prevalence of tuberculosis in patients with leukopenia was 9.1%, which was not significantly different from those in other groups (P> 0.05). From the factors affecting hospital infection, SLE patients hospitalized, more than two organs were damaged, before the infection with antibiotics, glucocorticoid and immunosuppressive therapy, hypoproteinemia and 24 h urine protein> 3.5 g The main risk factors of nosocomial infection, the infection rate was significantly higher than the control group. Conclusion Respiratory and skin mucosa are the most common sites of infection in patients with SLE. Gram-negative bacteria are the main pathogens in hospital, followed by Gram-positive bacteria. By reducing hospitalization time, effectively controlling the disease, cautious use of glucocorticoids and immunosuppressive agents, rational use of antibiotics, prevention of multiple organ dysfunction may reduce the incidence of nosocomial infections in SLE patients.