系统性红斑狼疮住院患者医院感染病原菌及其危险因素

Risk factors for hospital-associated infections and distribution of pathogens isolated from hospitalized patients with systemic lupus erythematosus

  • 摘要: 目的 分析系统性红斑狼疮(SLE)患者医院感染的病原菌分布及发生医院感染的危险因素,为临床预防和治疗提供循证依据。方法 回顾性分析2021年1月-2024年12月锦州医科大学附属第一医院收治的186例SLE患者的临床资料,根据是否发生医院感染分为感染组(n=56)和非感染组(n=130),分析两组患者的一般资料、临床特征、实验室指标和病原体分布特征,采用多因素logistic回归分析SLE患者发生医院感染的危险因素。结果 186例SLE患者中发生医院感染56例,感染率为30.11%,检出病原菌65株,其中革兰阳性菌40株(61.54%),革兰阴性菌20株(30.77%),真菌5株(7.69%); 感染部位以呼吸道感染占比最高(46.43%)。多因素logistic回归分析显示,合并糖尿病(OR=2.354,95%CI:1.032~5.372)、激素剂量≥1mg/(kg·d)(OR=3.436,95%CI:1.640~7.205)、SLE疾病活动指数(SLEDAI)评分≥10分(OR=2.333,95%CI:1.082~5.032)、血清白蛋白<30 g/L(OR=2.633,95%CI:1.196~5.801)是SLE患者发生医院感染的危险因素。结论 SLE患者医院感染率较高,病原菌以革兰阴性菌为主。合并糖尿病、大剂量激素使用、疾病活动度高、低白蛋白是发生医院感染的危险因素,临床应加强针对性预防措施。

     

    Abstract: OBJECTIVE To observe the distribution of pathogens isolated from the systemic lupus erythematosus(SLE) patients with hospital-associated infections(HAIs) and analyze the risk factors for the HAIs so as to provide evidence bases for clinical prevention and treatment. METHODS The clinical data were collected from 186 patients with SLE who were treated in The First Affiliated Hospital of Jinzhou Medical University from Jan. 2021 to Dec. 2024 and were retrospectively analyzed. The enrolled patients were divided into the infection group with 56 cases and the non-infection group with 130 cases according to the status of HAIs. The baseline data, clinical characteristics, clinical laboratory test indexes and distribution of pathogens were observed and compared between the two groups of patients. Multivariate logistic regression analysis was performed for the risk factors for the HAIs in the SLE patients. RESULTS Among the 186 SLE patients, 56 had HAIs, with the infection rate 30.11%. Totally 65 strains of pathogens were isolated, 40(61.54%) of which were gram-positive bacteria, 20(30.77%) were gram-negative bacteria, and 5 (7.69%)were fungi. The proportion of the patients who had respiratory tract infections was highest(46.43%). Multivariate logistic regression analysis indicated that complication with diabetes mellitus(OR=2.354,95%CI:1.032 to 5.372), dosage of hormone no less than 1mg/(kg·d)(OR=3.436,95%CI:1.640 to 7.205), score of SLE disease activity index (SLEDAI) no less than 10 points (OR=2.333,95%CI:1.082 to 5.032) and the serum albumin level less than 30 g/L(OR=2.633,95%CI:1.196 to 5.801) were the risk factors for the HAIs in the SLE patients. CONCLUSIONS The incidence of HAIs is high among the SLE patients, and the gram-negative bacteria are dominant among the pathogens. The complication with diabetes mellitus, large dose of hormones, high SLEDATI and low albumin level are the risk factors for the HAIs. It is necessary for the hospital to take targeted prevention measures.

     

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