浙江省3家医院阿尔茨海默病患者医院感染现状及病原菌特点和耐药性分析

Hospital Infection Situation and Pathogen Characteristics and Drug Resistance Analysis of Three Hospitals’ Alzheimer’s Patients in Zhejiang Province

关键词:  感染  医院感染  阿尔茨海默病  耐药性  病原菌

Key words:  infection  hospital infection  Alzheimer’s disease  pathogenic bacteria

摘要:

目的 分析阿尔茨海默病患者医院感染的临床现状及研究病原菌特点及耐药性，分析可能的原因以便更有针对性预防。方法 采用回顾性调查方法，收集老年阿尔茨海默病患者病历档案资料。统计2008年1月—2012年12月在选定的3家医院精神科、神经内科、老年科及干部病房住院的诊断为阿尔茨海默病的住院老年患者，调查分析其中发生医院感染的病例情况，并分析病原菌耐药特点和感染的可能原因。细菌鉴定与药敏试验严格按照《全国临床检验操作规程》进行操作。药敏试验采用K-B法，耐甲氧西林葡萄球菌检测采用CLSI推荐的头孢西丁纸片法。进行统一培训，进行质量控制。结果 本次调查的2 826例阿尔茨海默病患者，发生医院感染的共276例，304例次，感染率为9.77%，例次感染率为10.76%，感染部位以下呼吸道最为常见、其次是上呼吸道，然后依次是消化道、泌尿道、皮肤黏膜、血液及其他部位，呼吸道感染占全部医院感染的60%。276例送检者304份标本中共分离出病原菌384株。其中48份标本中检出细菌种数≥2，21例患者存在着多部位感染。其中革兰氏阴性菌281株，占全部病菌的73.18%，革兰氏阳性菌74株，占19.27%，真菌占7.55%。革兰氏阳性菌以金黄色葡萄球菌最多，达34株，占全部病原菌的8.85%，革兰氏阴性杆菌以铜绿假单胞菌最多，达84株，占全部病原菌的21.88%。结论 浙江三家医院阿尔茨海默病患者医院感染发生率较高，细菌耐药性严重；铜绿假单胞菌、肺炎克雷伯菌和大肠埃希氏菌为老年阿尔茨海默病主要致病菌。

Abstract:

OBJECTIVE To analysis the clinical status of hospital infection and research characteristics and drug resistance of pathogenic bacteria of Alzheimer’s patients, meanwhile to analyze the possible reasons for targeted prevention. METHODS The information of elderly alzheimer’s patients medical records was collected with the method of retrospective survey. The Alzheimer’s disease in elderly patients in neurology, elderly and cadre wards in the hospital diagnosed with in the above several psychiatric hospital from January 2008 to December 2008. Then the characteristics of the pathogen resistance and possible infection reason was analyzed. The bacteria identification and drug sensitive test was in strict accordance with the national clinical test procedures. We did the experiments with drug sensitive test using the K-B method and Methicillin-resistant staphylococcus aureus detection using cefoxitin paper method recommended by CLSI. RESULTS Among the survey of 2 826 cases of Alzheimer’s patients, the occurrence of nosocomial infection in 276 cases, 304 cases, infection rate was 9.77%, the cases of infection rate was 10.76%. The infection following respiratory tract was the most common, followed by the upper respiratory tract, and then followed by the digestive tract, urinary tract, skin and mucous membrane, blood and other parts, and furthermore the respiratory tract infection accounted for 60% of all hospital infection. The 384 strains pathogenic bacteria were isolated in 304 specimens. Of 48 specimens detected 2 or more bacterial species, 21 patients exist many site infection. 281 strains of gram-negative bacteria, accounted for 73.18% of the total bacteria, 74 strains of gram positive bacteria, accounted for 19.27%, fungi accounted for 7.55%. Staphylococcus aureus was mest common in gram-positive bacteria up to 34 strains, most accounted for 8.85% of all pathogenic bacteria, gram negative bacillus with Pseudomonas aeruginosa were 84 strains, accounting for 21.88% of all pathogenic bacteria. CONCLUSION There was a greater incidence of hospital infection and bacterial drug resistance at the same time Pseudomonas aeruginosa, Klebsiella pneumoniae and E. coli bacterium for elderly alzheimer’s disease are the main pathogenic bacteria in three hospitals in Zhejiang province.