Etiological Characteristics And Risk Factors Of Nosocomial Infection In Patients With Severe Trauma

Objective:To analyze the etiological characteristics and main risk factors of nosocomial infection in patients with severe trauma,and to provide theoretical basis for the empirical antibiotic therapy and the prevention of nosocomial infection.Methods:(1)The data of patients with severe trauma admitted in our hospital from January 2015 to December 2017 were analyzed retrospectively.According to the diagnostic criteria of nosocomial infection,the patients were included in the nosocomial group or non-hospital group.(2)Analyze the nosocomial infection rate,the main sites of nosocomial infection and the types of pathogens and the risk factors for hospital infection were analyzed.Results:(1)The incidence of nosocomial infection in patients with severe trauma was58.01%,Respiratory tract was the most common infection site,accounting for47.89%,followed by wound,accounting for 20.42%.(2)A total of 177 strains of pathogenic bacteria were isolated,of which gram-negative bacteria accounted for65.54%,gram-positive bacteria for 31.07%and fungi for 3.39%.The G~-bacteria mainly including Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli,The G~+mainly including Staphylococcus aureus,Staphylococcus epidermidis and Enterococci.The specimens are mainly derived from phlegm,wound,blood and urine.(3)The detection rate of MRSA was 75.0%and there were no vancomycin and linazolamide resistant strains.The positive rate of ESBLs in Klebsiella was71.43%(15/21),and imipenem and amikacin are the most sensitive.The positive rate of ESBLs in Enterococci was 63.2%(12/19),and imipenem,amikacin and ticacillin/potassium clavulanate are the most sensitive.(4)Multivariate Logistic regression analysis showed that low albumin level,age,long time use of mechanical ventilation,gastric tube,enteral nutrition and antibiotics were independent risk factors for patients with severe trauma.Conclusion:(1)Gram-negative bacteria were the most common infection in severe trauma patients,Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli were the most common,followed by Gram positive bacteria,Staphylococcus aureus was the most common.(2)Respiratory tract infection is the most common infection in severe trauma patients,followed by wound and blood.(3)Low albumin level,age,mechanical ventilation,gastric tube,enteral nutrition and long time use of antibiotics are independent risk factors for nosocomial infection in patients with severe trauma.