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目的:探讨皮肌炎(dermatomyositis,DM)和多发性肌炎(polymyositis,PM)患者并发医院感染的临床特点及其相关因素。方法:对75例DM和PM住院患者进行回顾性调查、分析及总结。结果:75例DM和PM患者住院186例次,发生医院感染者89例次,医院感染率47.8%。医院感染最常见的部位是上呼吸道(28.1%),其次分别是肺部(25.8%)和皮肤黏膜(12.4%)。医院感染病原体中,革兰阴性菌28株(53.9%),革兰阳性菌20株(38.5%),真菌4株(7.6%);位于前3位的病原菌分别是铜绿假单胞菌(17.3%)、肺炎克雷伯菌(13.5%)及金黄色葡萄球菌(9.7%)。病原体药敏试验示阿米卡星、氨曲南和亚安培南对革兰阴性菌疗效好,且耐药率低;而万古霉素及克林霉素对革兰阳性菌疗效好,且耐药率低。患者住院时间、糖皮质激素及免疫抑制剂治疗、血清白蛋白水平、是否并发糖尿病和侵袭性操作等是DM和PM患者并发医院感染的高危因素。结论:DM和PM患者并发医院感染发生率高,且主要病原菌为革兰阴性菌。应针对相关高危因素采取合理措施,以有效预防其感染的发生,促进患者早日康复。
Objective: To investigate the clinical features and related factors of nosocomial infections in patients with dermatomyositis (DM) and polymyositis (PM). Methods: 75 cases of DM and PM inpatients were retrospectively analyzed, analyzed and summarized. Results: Among the 75 patients with DM and PM, 186 were hospitalized, 89 were hospital-acquired and 47.8% were hospital-acquired. The most common site of nosocomial infection was the upper respiratory tract (28.1%), followed by the lungs (25.8%) and mucocutaneous linings (12.4%). Among the nosocomial infection pathogens, 28 (53.9%) were gram-negative bacteria, 20 (38.5%) were gram-positive bacteria and 4 (7.6%) were fungi. The pathogens in the top 3 were Pseudomonas aeruginosa (17.3 %), Klebsiella pneumoniae (13.5%) and Staphylococcus aureus (9.7%). Pathogenic susceptibility tests showed that amikacin, aztreonam and amlodipine have a good effect on Gram-negative bacteria, and the drug resistance rate is low; however, vancomycin and clindamycin are effective against Gram-positive bacteria and are resistant to Low drug rates. Patient length of hospital stay, glucocorticoid and immunosuppressive agents, serum albumin levels, concurrent diabetes, and invasive procedures are all risk factors for nosocomial infections in DM and PM patients. Conclusion: The incidence of nosocomial infections in DM and PM patients is high, and the main pathogens are Gram-negative bacteria. Should take appropriate risk factors to take reasonable measures to effectively prevent the occurrence of their infection and promote early recovery of patients.