Association between APACHE II score and nosocomial infections in intensive care unit patients: A multicenter cohort study

Objective To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. Methods Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0–5, 6–10, 11–15, 16–20, 21–25, 26–30, and 31+). Results There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. Conclusions Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.     

ICU患者合并医院感染的危险因素及预防对策

目的 探讨ICU患者合并医院感染的危险因素及预防对策.方法 回顾性分析490例ICU患者的临床资料,进行感染组与非感染组可能引起医院感染相关因素比较.结果 490例ICU患者发生医院感染50例,感染率为10.20％,其中医院内获得性肺炎30例、消化道感染10例、泌尿道感染6例、其他4例;感染组与非感染组比较,感染组年龄大、创伤性诊疗操作多、预防应用抗菌药物比例高、抑酸剂、激素应用时间及住院时间长,是医院感染的危险因素(P＜0.05).结论 ICU患者医院感染率较高,应尽可能减少和避免危险因素的发生.     

Identifying new risk factors for Pseudomonas aeruginosa pneumonia in intensive care units: experience of the French national surveillance, REA-RAISIN

Pseudomonas aeruginosa is an important pathogen of complicated pneumonia in intensive care units (ICUs). Our objective was to determine 'patient' and 'ward' risk factors for P. aeruginosa pneumonia among patients with nosocomial pneumonia in ICU. Data from the 2004-2006 prospective French national nosocomial infection surveillance in ICUs (REA-RAISIN) were used, including patients admitted for >48 h in ICU and who developed nosocomial pneumonia. Only first pneumonia was considered and categorised as either P. aeruginosa pneumonia or other micro-organism pneumonia. Multilevel logistic regression model (patient as first level and ward as second) with P. aeruginosa pneumonia as binary outcome was performed. Of 3,837 included patients from 201 different wards, 25% had P. aeruginosa pneumonia. P. aeruginosa was significantly more frequent in late onset pneumonia. Higher probability of P. aeruginosa pneumonia was associated with higher age and length of mechanical ventilation, antibiotics at admission, transfer from a medical unit or ICU, and admission in a ward with higher incidence of patients with P. aeruginosa infections. Lower probability of P. aeruginosa was associated with traumatism and admission in a ward with high patient turnover. Our analyses identified a patient's profile and some ward elements that could make suspect P. aeruginosa in case of nosocomial pneumonia.     

Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study.

OBJECTIVE: To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS. DESIGN: Pairwise-matched (1:2) exposed-unexposed study. SETTING: 10-bed medical-surgical ICU and an 18-bed medical ICU. PATIENTS: Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables. METHODS: Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality. RESULTS: CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI95, 0.76-2.61; P=.27). CONCLUSION: CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.     

基层医院ICU医院感染危险因素调查分析

目的：了解某基层医院ICU患者医院感染现状,分析发生医院感染的危险因素,为基层医院制定医院感染防控措施提供依据。方法对2013年全年某基层医院ICU住院病人进行目标性监测,汇总分析资料。用Microsoft Of-fice Excel 2003搜集整理资料,用SPSS17．0进行统计学分析。结果共监测ICU患者1892例,医院感染63例次,例次感染率为3．33％。 ICU住院时间小于10天组,医院感染发生率为12．33％,大于20天组,感染率为21．59％。有基础疾病组医院感染率高于无基础疾病组。病情分级为E级的患者医院感染率高于其他组。结论应针对医院感染的危险因素及时采取预防控制措施、有针对性地对引起感染的高危因素进行评估和管理减少医院感染发生。     

Relationship between nosocomial infection and mortality in a neurology intensive care unit in Turkey

Few previous studies have evaluated the relationship between nosocomial infection and mortality in a neurology intensive care unit (ICU). In this study, patients treated for more than 24h in the neurology ICU of the Ankara Training and Research Hospital, Turkey were followed until death or two days after discharge by prospective daily surveillance. The study period was 14 months. One hundred and sixty-nine ICU-acquired infections occurred in 74 (38.9%) of 190 patients during 2006 patient-days. The overall rate of ICU-acquired nosocomial infection was 88.9/100 patients and 84.2/1000 patient-days. While the overall mortality rate was 60%, mortality in patients with nosocomial infections was 69%. In univariate analysis, infection (nosocomial and community-acquired) (P=0.002), nosocomial infection (P<0.05), mechanical ventilation (P<0.0001), presence of two or more underlying diseases (P=0.01), parenteral nutrition (P<0.0001), steroid treatment (P=0.003) and a low Glasgow Coma Scale (GCS) score (P=0.0001) were identified as risk factors for mortality. Stepwise logistic regression analysis showed nosocomial infection (P<0.05), mechanical ventilation (P=0.009), the presence of two or more underlying diseases (P<0.05) and a low GCS score (P=0.0001) to be risk factors for ICU mortality. It was concluded that nosocomial infection increases the risk of mortality by a factor of 1.69. The impact of nosocomial infection on mortality in our ICU was higher in patients with high GCS scores and patients aged between 66 and 75 years. In particular, nosocomial infection increased mortality among patients with less severe illnesses.     

Surveillance results of nosocomial infections of the ICU in Kenézy Hospital, based on two years data

INTRODUCTION: According to data in the literature, the number of nosocomial infections in the ICU is far higher than in non-ICU patients. As a result of improving lifesaving technologies, the risk of nosocomial infections increases in ICUs. Utilization of epidemiological methods is recommended for the detection and follow up of nosocomial infections. Aims: Prospective surveillance to assess the epidemiology of nosocomial infections in an ICU. METHODS: Kenézy Hospital is a country hospital with 1637 beds and a 16-bed central ICU. During the investigated period (01. 04. 2004-31. 03. 2006) 1490 patients, with a total 8058 ICU days, were hospitalised in the mixed medical-surgical ICU. The commonest primary diagnosis were respiratory failure, multiple trauma and head injury. Surveillance was performed by a trained infection control nurse and was supervised by an infection control physician and infectious disease physician. CDC definitions were used to define nosocomial infections. RESULTS: A total of 194 nosocomial infections in 134 patients were detected during the study period. The overall incidence and incidence density of nosocomial infections were 13.0 per 100 patients and 24.0 per 1000 patient-days. Respiratory tract infections (44.3%) were the most frequent nosocomial infection, followed by urinary tract (21.1%) and bloodstream infections (20.1%). CONCLUSIONS: Nosocomial surveillance is useful in detecting nosocomial infections in ICU. A multidisciplinary approach and partnership between the physicians and infection control nurses is needed. Patient-to-nurse ratio is an independent risk factor for nosocomial infections in intensive care, this must be kept in mind when planning rationalization of the number of nursing staff.     

Factors influencing hospital infection in patients in the intensive care unit

OBJECTIVE: The accumulation of risk factors in hospitalized patients is one of the elements contributing to the increase in the frequency of nosocomial infection in the intensive care unit (ICU). Our aim was to identify nosocomial infection risk factors in the ICU of our hospital. METHODS: We performed a prospective cohort study of 1,134 patients admitted to the ICU for at least 24 hours in 2001. The patients were followed-up for 48 hours after leaving the ICU. Multivariate Cox regression analysis was used to identify risk factors. RESULTS: The intrinsic risk factors identified were the principal diagnosis motivating admission to the ICU, traumatic brain injury and renal insufficiency. Invasive techniques that were independently associated with nosocomial infection (from high to low risk) were urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheter, and total parenteral nutrition. CONCLUSIONS: Although endogenous risk factors, which cannot be modified, represented the most important associated factors, steps to reduce nosocomial infections should concentrate on the following exogenous risk factors: urinary catheter, tracheostomy, mechanical ventilation, Swan-Ganz catheters, and total parenteral nutrition.     

重症监护室患者医院感染病原菌及其影响因素

目的分析医院重症监护室(ICU)患者医院感染病原菌及其影响因素,并总结其防治对策。方法采用回顾性调查法调查2014-2018年安徽医科大学第一附属医院ICU患者的病历资料,统计医院感染及其病原菌情况,收集所有医院感染患者临床资料,归纳ICU患者医院感染的影响因素,总结防治措施。结果共调查2 980例ICU患者,发生医院感染147例,感染率为4.93%;2014-2016年医院感染率分别为5.69%、4.97%、4.84%,呈降低趋势,2017年(5.60%)有上升,2018年有所降低(4.01%);感染部位以下呼吸道(61.22%)、泌尿系统(12.24%)、血管(8.84%)为主;医院感染病原菌以革兰阴性菌(69.87%)为主,位列前三致病菌分别为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;其次为革兰阳性菌(18.91%),以金黄色葡萄球菌检出率(11.54%)最高;真菌(11.22%)中以白假丝酵母检出率(4.49%)最高;年龄、基础疾病、住院时间、泌尿系统插管、使用呼吸机、气管插管、气管切开是ICU患者医院感染的影响因素(P<0.05)。结论 2014-2018年ICU医院感染率整体呈降低趋势,医院感染病原菌以革兰阴性菌感染为主,高龄、合并多种基础疾病、住院时间延长及介入诊疗均为ICU患者发生医院感染的影响因素。为降低ICU医院感染率,应尽可能减少非必要介入性诊疗操作,避免滥用抗菌药物,严格参照药敏试验结果选择敏感性抗菌药物,对高危人群重点监测,对介入性诊疗病例强化感染监测。     

Hospital infections and risk factors in the intensive care units of 16 Dutch hospitals, results of surveillance of quality assurance indicators]

OBJECTIVE: To gain insight into the incidence of nosocomial infections and associated risk factors in Intensive Care Units (ICUs). DESIGN: Prospective. METHOD: From July 1997 to December 1999, standardised surveillance of nosocomial infections was implemented in ICUs in 16 hospitals in the Netherlands. Surveillance was performed in patients with an ICU stay of > or = 48 hrs; data were collected from admission until discharge from ICU. Data-collection included demographic data and patient- and treatment-related risk factors. The data were aggregated in a national database. RESULTS: In the research period, hospitals sent good quality data for aggregation in the national database on 2795 patients (61% male) and 27,922 ICU patient days. The median length of stay was six days, the median 'Acute physiology and chronic health evaluation' (APACHE) II score was 17 and the median age was 67 years. A total number of 749 infected patients were found with 1,177 nosocomial infections (27% of patients, 42 infections/1000 patient days), consisting of 43% pneumonia, 20% sepsis, 21% urinary tract infections, 16% other types of infections. Out of all the patients, 62% was on mechanical ventilation, 64% had a central venous line and 89% had a urinary catheter in situ. Selective decontamination of the gastrointestinal tract was used for 12% of the patients, and systemic antibiotics for 68%. Micro-organisms most frequently isolated were Pseudomonas aeruginosa in patients with pneumonia, Staphylococcus epidermidis in catheter-related bloodstream infections and Escherichia coli in patients with urinary tract infections. Large differences in device use and incidence of infections were observed between the ICUs. CONCLUSION: The aggregated data gave insight into the incidence of nosocomial infections and associated risk factors in ICUs. The data are meant as references to support decision- and policy-making in local infection control programs.     

Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit.

OBJECTIVES: To assess the influence of nosocomial infection on length of stay in the intensive care unit (ICU) and to determine the relative effect of other factors on extra length of hospitalization associated with nosocomial infection. DESIGN: Prospective cohort multicenter study in the context of the ENVIN-UCI project. SETTING: Medical or surgical ICUs of 49 different hospitals in Spain. METHODS: All consecutive patients (N = 6,593) admitted to ICUs of the participating hospitals who stayed for more than 24 hours during a 3-month period (from January 15 to April 15, 1996) were included. Length of ICU stay was compared between patients with and without nosocomial infections. RESULTS Uninfected patients (N = 5,868) had a median stay in the ICU of 3 days, whereas the median for infected patients (N = 725) was 17 days (P < .001). The median for infected patients with one episode of nosocomial infection was 13 days. The greatest length of stay (40 days) was among patients admitted to the ICU because of medical diseases, with an infection acquired before admission to the ICU, and with the largest number of nosocomial infection episodes. In extended stays, nosocomial infection was significantly associated with length of hospitalization (day 21; odds ratio, 22.38; 95% confidence interval 16.6 to 30.4), whereas an effect of variables related to severity of illness on admission (Acute Physiology and Chronic Health Evaluation II score, urgent surgery, and infection prior to ICU admission) was not found. CONCLUSIONS: The presence of nosocomial infection and the number of infection episodes were the variables with the strongest association with prolonged hospital stay among ICU patients.     

重症监护病房医院感染的现状及干预对策

目的调查重症监护病房(ICU)医院感染的现状和危险因素,以制定干预对策。方法采取前瞻性监测与回顾性调查相结合的方法,对198例医院感染病例进行统计分析。结果我院ICU医院感染以下呼吸道为主,占69.4%,危险因素为老年人、住院日长、大量使用抗生素、严重基础疾病和侵入性诊疗技术等。结论ICU医院感染应采取综合性干预对策,切实降低感染率,提高抢救成功率。     

ICU发生院内感染的危险因素调查分析

目的：调查分析ICU发生院内感染的危险因素,并为预防ICU发生院内感染提供依据。方法：根据是否发生院内感染将入住本院重症监护病房的391例患者分为试验组和对照组。分别对所有患者进行手术治疗、气管切开治疗、气管插管治疗、泌尿道插管治疗、住ICU时间大于10 d等相应的操作,并对这些因素进行分析。结果：391例患者的ICU院内感染率为25.8%。多因素分析ICU院内感染,表明泌尿道插管治疗、气管插管治疗、住ICU时间大于10 d及机械通气时间大于5 d是ICU发生院内感染的危险因素。结论：避免院内感染,在加强防范意识、增强无菌观念的基础上,减少患者住院时间、减少机械通气时间、减少对患者的侵袭性操作等是减少院内感染的发生的有效措施。     

ICU医院感染相关因素分析

目的 探讨重症监护病房(ICU)合并医院感染影响因素及护理对策.方法 选择重症监护病房460例患者作为研究对象,以医院感染患者为观察组,按照1∶1比例选择未合并医院感染患者作为对照组,比较两组可能影响医院感染因素差异.结果 460例患者中发生医院感染80例,感染率17.39％,包括呼吸道感染、泌尿系统感染、导管相关性感染,单因素检验结果显示,10个变量是医院感染的相关因素(P＜0.05),logistic回归分析引起医院感染的危险因素为:年龄大、实施侵入性操作、APACHEⅡ评分高、预防应用抗菌药物,其OR值分别为3.29、3.04、2.94、2.45.结论 重症监护病房医院感染发生率较高,是多种因素作用的结果,改善老年患者的自身状况、加强危重患者治疗、合理使用抗菌药物、严格无菌操作,可降低ICU医院感染率.     

ICU患者医院感染危险因素分析及对策

目的 探索ICU患者的医院感染发生的危险因素.方法 采用前瞻性调查方法,对2009年1月1日—2010年12月30日收治ICU治疗≥48 h的421例患者进行调查分析.结果 421例符合条件的患者中,129例患者发生医院感染,感染率为30.64％;昏迷、气管切开、机械通气、低白蛋白血症是医院感染发生最危险因素.结论 ICU应根据医院感染发病的危险因素,及时采取相应的预防措施.     

Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards

Critically ill patients, eligible for admission into intensive care units (ICUs), are often hospitalized in other wards due to a lack of ICU beds. Differences in morbidity between patients managed in ICUs and elsewhere are unknown, specifically the morbidity related to hospital-acquired infection. Patients fitting ICU admission criteria were identified by screening five entire hospitals on four separate days. Hospital infections within a 30-day follow-up period were compared in ICU patients and in patients on other wards using Kaplan-Meier curves. Residual differences in the patients' case mix between ICUs and other wards were adjusted for utilizing multivariate Cox models. Of 13415 patients screened, 668 were critically ill. The overall infection rates (per 100 patient-days) were 1.2 for bloodstream infection (BSI) and 1.9 for urinary tract infection (UTI). The adjusted hazard ratios in ICU patients compared with patients on regular wards were 3.1 (P<0.001) for BSI and 2.5 (P<0.001) for UTI. This increased risk persisted even after adjusting for the disparity in the number of cultures sent from ICUs compared with ordinary wards. No interdepartmental differences were found in the rates of pneumonia, surgical wound infections and other infections. Minimizing the differences between characteristics of patients hospitalized in ICUs and in other wards, and controlling for the higher frequency of cultures sent from ICUs did not eliminate the increased risk of BSI and UTI associated with admission into ICUs.     

ICU住院患者医院感染及危险因素分析

目的 探讨ICU住院患者并发医院感染的发生率及其相关危险因素,提出预防ICU医院感染的对策.方法 对1314例ICU住院患者进行回顾性调查,根据医院感染诊断标准将其分为感染组(139例)和未感染组(1175例);分析ICU住院患者的医院感染率,采用单因素χ2检验、多因素逐步Logistic回归法来筛选ICU住院患者并发...     

综合性ICU医院感染的危险因素分析

目的 了解医院综合ICU患者医院感染的危险因素.方法 采用前瞻性监测方法,对医院2008年1-12月330例ICU住院患者发生医院感染与基础疾病、年龄、侵入性操作的关系及病原菌状况等方面进行了综合分析,并根据病情予以分级评定.结果 医院感染发病宰为33.64%,其中死因与医院感染有关者占死亡例数的35.35%;感染部位以下呼吸道感染为主(68.71%),双重以上感染率为11.21%;病原菌居前3位的分别是铜绿假单胞菌(15.74%)、鲍氏不动杆菌(12.04%)、嗜麦芽寡养单胞黹(11.57%);住院人数、泌尿道插管、呼吸机、昏迷等是医院感染的高危因素(P<0.05).结论 ICU医院感染发生率高,引起医院感染的高危因素多而复杂,应采取有效措施减少ICU医院感染的发生率.     

ICU老年患者医院感染经济学损失病例对照研究

目的 研究ICU老年患者医院感染所造成的直接经济损失.方法 采用回顾性调查和前瞻性监测的方法,调查2004年1月1日-2010年12月31 日某省级医院ICU的老年患者,共1152例,按条件1∶1配比,发生医院感染的患者为感染组,未发生医院感染的患者为对照组,比较两组的平均住院总费用、药费和住院天数的差异.结果 感染组住院总费用平均为91 710.67元/例,对照组住院总费用平均为32 021.51元/例;医院感染经济学损失平均为59 689.16元/例,感染组显著高于对照组(P＜0.05);感染组药费平均为48 717.45元/例,对照组药费平均为14 276.88元/例,增加的药费支出为34 440.57无/例,感染组显著高于对照组(P＜0.05);感染组住院天数平均为21.0d/例,对照组住院天数平均为7.5 d/例,每例延长住院天数13.5 d;感染组显著高于对照组(P＜0.05).结论 老年患者是医院感染的高危人群,老年患者医院感染造成的经济损失较大,应采取有效措施,降低老年患者医院感染发生率,减少医院感染经济损失.     

Use of multistate models to assess prolongation of intensive care unit stay due to nosocomial infection.

BACKGROUND: Reliable data on the costs attributable to nosocomial infection (NI) are crucial to demonstrating the real cost-effectiveness of infection control measures. Several studies investigating this issue with regard to intensive care unit (ICU) patients have probably overestimated, as a result of inappropriate study methods, the part played by NIs in prolonging the length of stay. METHODS: Data from a prospective study of the incidence of NI in 5 ICUs over a period of 18 months formed the basis of this analysis. For describing the temporal dynamics of the data, a multistate model was used. Thus, ICU patients were counted as case patients as soon as an NI was ascertained on any particular day. All patients were then regarded as control subjects as long as they remained free of NI (time-to-event data analysis technique). RESULTS: Admitted patients (n=1,876) were observed for the development of NI over a period of 28,498 patient-days. In total, 431 NIs were ascertained during the study period (incidence density, 15.1 NIs per 1,000 patient-days). The influence of NI as a time-dependent covariate in a proportional hazards model was highly significant (P< .0001, Wald test). NI significantly reduced the discharge hazard (hazard ratio, 0.72 [95% confidence interval, 0.63-0.82])--that is, it prolonged the ICU stay. The mean prolongation of ICU length of stay due to NI (+/- standard error) was estimated to be 5.3+/-1.6 days. CONCLUSIONS: Further studies are required to enable comparison of data on prolongation of ICU length of stay with the results of various study methods.