Clinical Analysis Of Nosocomial Infections In Neurological Intensive Care Unit

Objective To analyze the risk factors,pathogen and drug resistance of nosocomial infections in NICU,to identify high-risk groups of nosocomial infections as early as possible and reduce the incidence of nosocomial infections.Methods The clinical data of 331 patients who were admitted to the neurology intensive care unit of the First People's Hospital of YinChuan were retrospectively analysed from Jan 2015 to Dec 2017.The general data(age,sex,et al.),clinical data(primary disease,past history,operation history,et al.),test results(blood leukocyte count,blood lactic acid,et al.),diagnosis and treatment situation,invasive operation and so on were analyzed with SPSS17.0.The categorical data was evaluated by Chi-square test or Fisher's exact test.The measurement data was evaluated by T test or rank sum test;They were used to analyze the related risk factors of nosocomial infection.Logistic regression was used in multifactor analysis.The incidence of nosocomial infection,the ratio of type of infection,the proportion of infection sites,the ratio of pathogenic bacteria species composition,and drug resistance of pathogenic bacteria were also calculated.Results 331 cases were included,of which 47 cases of nosocomial infection,the incidence of nosocomial infection was 14.2%.Among them,the incidence of nosocomial infection in intracranial infection and intracerebral hemorrhage was high,accounted for 25% and 15.32%.The mortality of nosocomial infection in NICU patients was higher than that in those without nosocomial infection(P<0.01).The single factor experiment results showed that the differences of age more than 60 years,previous surgery history,previous stroke history,smoking,drinking,consciousness,blood lactic acid,blood transfusion,parenteral nutrition,tracheal intubation/ tracheotomy,catheterization,indwelling gastric tube,leukocyte of urine,the bacterial count of urine,blood leukocyte,total protein,albumin,D-dimer between the two groups were statistically significant(P<0.05);Indwelling gastric tube(OR=40.392,95%CI:0.031~0.159)and the increase of urinary bacterial count(OR=5.905,95%CI: 0.979~0.998),the increased blood leukocyte(OR=7.712,95 % CI: 0.789 ~ 0.960),hypoproteinemia(OR=7.598,95%CI: 1.033~1.211)were the independent risk factors of nosocomial infection in NICU;The most common infection sites of nosocomial infection were lower respiratory tract and urinary tract,accounted for76.92% and 11.54%;Pathogenic bacteria was gram negative Bacilli,accounting for 73.91%;Klebsiella pneumoniae subspecie and Escherichia coli were the most common species,accounting for 26.09% and 21.73% respectively.The subspecies of Klebsiella pneumoniae were resistant to ampicillin,and Escherichia coli was resistant to cefazolin,ampicillin,ampicillin Shubatan,ciprofloxacin,levofloxacin,gentamicin,and compound novamoxin.Conclusion 1.Indwelling gastric tube and urinary bacterial count,the increased blood leukocyte,hypoproteinemia were the independent risk factors of nosocomial infection in NICU;2.NICU nosocomial pathogens were mainly gram-negative bacilli,among which Klebsiella pneumoniae pneumonia subspecies and Escherichia coli were the main pathogens.3.Nosocomial infection can significantly increase the mortality of the patients.We should attach great importance to it,and identify related risk factors as early as possible so as to reduce the incidence of nosocomial infections.