An Analysis Of Characteristics And Risk Factors Of Hospital-acquired Infections With Multidrug Resistant Organism For Patients With Type 2 Diabetes

Objective:To investigate the characteristics and risk factors of hospital-acquired infections with multidrug resistant organism for patients with type 2 diabetes, and provide scientific evidence for clinical prevention and the usage of antibacterial agents.Methods:A retrospective study was carried out on the data of 179 patients with type 2 diabetes who had hospital-acquired infections in Qilu Hospital of Shandong University from January 2014 to December 2015. Then the patients divided into the A group(multidrug resistant organism infections) with 67 cases and the B group (non-multidrug resistant organism infections) with 112 cases according to combined with the nosocomial multidrug resistant organism infections or not. The characteristics of multidrug resistant organism infections of type 2 diabetes patients hospital infection was analyzed by description epidemiological methods. The age, gender, course of disease, underlying diseases, hospital stay, fasting blood glucose, glycosylated hemoglobin, complications of diabetes, invasive operation and application of drug therapy before infection were analyzed by the Chi-square test and multivariate logistic regression analysis to explore risk factors of multidrug resistant organism infections. All statistical description and analysis was conducted by SPSS 19.0.Results:(1) Status of type 2 diabetes with hospital-acquired infections:The nosocomial infection rate of type 2 diabetes was higher than without type 2 diabetes during the same period in our hospital(P<0.05). While the rate of nosocomial infection in patients without type 2 diabetes, type 2 diabetes patients remained stable, type 2 diabetes patients with nosocomial multidrug resistant organism infection was the rise trend, increasing by ten percent.(2)The characteristics of hospital-acquired infections with multidrug resistant organism: ① Type 2 diabetes nosocomial multidrug resistant organism infections were mainly distributed in Intensive Care Unit ward, accounted for 29.9%, respiratory tract infection accounted for most (61.43%). ②Among those pathogens, Fifty-six strains(64.37%)were Gram-negative bacteria, the most strains were Baumanii (27.58%). Thirty-one strains (35.63%)were Gram-positive bacteria and the most common ones were Staphylococcus aureus (24.13%), Fungi were not detected, there were specimens of 20 cases of mixed infections. The Gram-positive multidrug resistant organism were more sensitive to vancomycin, linezolid and daptomycin. Gran negative multidrug resistant organism were generic drug resistance, antibiotic treatment options were limited.(3)The risk factors of hospital-acquired infections with multidrug resistant organism infections: ①The univariate analysis showed that the risk factors of the nosocomial multiple drug-resistant infections included hospital stay≥20d, fasting blood glucose≥10mmol/L, glycosylated hemoglobin>9.0%, invasive operation and application of drug therapy before infection. ②The multivariate logistic regression analysis indicated that hospital stay>20d (OR=2.039), glycosylated hemoglobin >9.0%(OR=1.609), invasive operation (OR=2.646) and application of antibacterial agents therapy for thirty days before infection(OR= 1.670) were the independent risk factors for the multidrug resistant organism infections in the type 2 diabetes patients.Conclusion:① Nearly two years, the rate of type 2 diabetes patients with multi-resistant bacteria infection is on the rise in our hospital. ②Type 2 diabetes nosocomial multidrug resistant organism infections are mainly distributed in Intensive Care Unit ward, respiratory tract infection is most. Opportunistic pathogens are the main pathogens, gram-negative strains is the most common bacteria in wounds of multidrug resistant organism infections, and the second is Gram-positive strains. Fungus is no in those patients. When we use antimicrobial agents depend on clinic experience, our suggestion is that antibiotics are against gram-negative bacteria and vancomycin, linezolid and daptomycin are the first choice against gram-positive bacteria. Because gran negative multiple drug-resistant bacteria are generic drug resistance, antibiotic treatment choice is very difficult, it is particularly important to cut infection for reducing the infection rate. Common bacterial culture and drug sensitivity test should be conducted as early as possible so that appropriate antimicrobial agents could be chosen in order to prevent the generation of drug-resistance.④Hospital stay≥20d, glycosylated hemoglobin>9.0%, invasive operation and application of antibacterial agents therapy for thirty days before infection are the independent risk factors, it is an effective way to prevent the nosocomial multidrug resistant organism infections in the type 2 diabetes mellitus patients for controlling the blood glucose level, shorten hospital stay, rigidly implementing the aseptic technical operation procedures and reasonable application of antibacterial agents.