两种评分对NICU医院感染风险的临床研究

目的探讨格拉斯哥昏迷评分(GCS)与急性生理功能及慢性健康状况评分Ⅱ(APACHEⅡ)用于神经内科重症监护病房(NICU)医院感染风险预警的可行性。方法回顾性的对216例NICU患者进行入院<24hGCS评分和APACHEⅡ评分,依据评分结果将患者分组,研究组间医院感染率、平均住院日及器械使用日的统计差异性。结果按照APACHEⅡ评分分组的高、中及低危组患者的医院感染率分别为28.6%、19.7%、7.5%,差异有统计学意义(P<0.05);各组患者的平均住院日和器械使用日之间比较,差异有统计学意义(P<0.05)。结论GCS与APACHEⅡ评分不仅可用于NICU患者医院感染风险预警,还可用于患者住院日和器械使用日的初步预测。     

Intensive-care-unit-acquired bloodstream infections in a regional critically ill population

Bloodstream infection (BSI) is a serious complication of critical illness but it is uncertain whether acquisition of BSI in the intensive care unit (ICU) increases the risk of death. A study was conducted among all Calgary health region (population approximately 1 million) adults admitted to ICUs for 48 h or more during a three-year period to investigate the occurrence, microbiology and risk factors for developing an ICU-acquired BSI and to determine whether these infections independently predict mortality. One hundred and ninety-nine ICU-acquired BSI episodes occurred during 4933 ICU admissions for a cumulative incidence of 4% and an incidence density of 5.4 per 1000 ICU days. The most common isolates were Staphylococcus aureus (18%), coagulase-negative staphylococci (11%), and Enterococcus faecalis (8%); 12% of infections were due to antimicrobial-resistant bacteria. Admission to the regional neurosurgery/trauma ICU [odds ratio (OR) 2.86; 95% confidence interval (CI) 2.10-3.90] and increasing Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.05 per point, 95% CI 1.03-1.07) were associated with higher risk, whereas a surgical diagnosis (OR 0.69; 95% CI 0.52-0.93) was associated with lower risk of developing ICU-acquired BSI in logistic regression analysis. The crude in-hospital death rate was 45% for patients with ICU-acquired BSI compared with 21% for those without (P < 0.0001) Development of an ICU-acquired BSI was an independent risk factor for death (OR 1.79; 95% CI 1.3-2.5) and increases the risk of dying from critical illness.     

Cost of intensive care unit-acquired bloodstream infections

Intensive care unit-acquired (ICU-acquired) bloodstream infections (BSI) are an important complication of critical illness. The objective of this study was to quantify the excess length of stay, mortality and cost attributable to ICU-acquired BSI. A matched cohort study was conducted in all adult ICUs in the Calgary Health Region between 1 May 2000 and 30 April 2003. One hundred and forty-four patients with ICU-acquired BSI were matched (1:1) to patients without ICU-acquired BSI. Patients with ICU-acquired BSI had a significantly increased median length of ICU stay {15.5 [interquartile range (IQR) 8-26] days vs 12 [IQR 7-18.5] days, P=0.003} and median costs of hospital care [85,137 dollars (IQR 45,740-131,412 dollars) vs 67,879 dollars (IQR 35,043-115,915 dollars, P=0.02) compared with patients without ICU-acquired BSI. The median excess length of ICU stay was two days and the median cost attributable to ICU-acquired BSI was 12,321 dollars per case. Sixty (42%) of the cases died compared with 37 (26%) of the controls [P=0.002, attributable mortality 16%, 95% confidence interval (CI) 5.9-26.0%]. Patients with ICU-acquired BSI were at increased risk for in-hospital death (odds ratio=2.64, 95%CI 1.40-5.29). Among survivor-matched pairs, the median excess lengths of ICU and hospital stay attributable to development of ICU-acquired BSI were two and 13.5 days, respectively, and the attributable cost due to ICU-acquired BSI was 25,155 dollars per case survivor. Critically ill patients who develop ICU-acquired BSI suffer excess morbidity and mortality, and incur significantly increased healthcare costs. These data support expenditures on infection prevention and control programmes and further research into reducing the impact of these infections.     

Secondary carriage with multi-resistant Acinetobacter baumannii and Klebsiella pneumoniae in an adult ICU population: relationship with nosocomial infections and mortality

A one year prospective, observational survey was performed to evaluate the abnormal carriage of multi-resistant Klebsiella pneumoniae and/ or Acinetobacter baumannii, to determine associated risk factors for carriage, and to correlate the abnormal carriage with infectious morbidity and mortality in the intensive care unit (ICU) of a University Hospital. Two hundred and ninety-eight patients who stayed in the ICU >48h, and were not neutropenic, were studied. Salivary and rectal samples were obtained on admission and weekly until discharge. Out of 265 evaluable patients, 88 (33%) developed oropharyngeal and/or rectal carriage within a median of nine days. Three factors were significantly associated with abnormal carriage: higher 'severity of illness' score on admission, a threefold increase in ICU stay, and the need for mechanical ventilation. K. pneumoniae or A. baumannii accounted for 57/158 (36%) of all ICU-acquired infections (in 46 patients). They were considered as secondary endogenous infections (SEI) in 42 patients who were previously colonized with the same strains, and developed infection within a median of three days (range 0–68 days). Prolonged stay in ICU was the only factor associated with SEI in the carrier population. Mortality was significantly greater in the carrier group (43 vs 25%, P = 0·0006). Post hoc stratification suggested that abnormal carriage only influenced mortality in patients showing a low severity of illness score on admission to ICU. Abnormal carriage was found in the most severely ill patients, predisposed to secondary nosocomial infections, and could influence mortality in the less severely ill.     

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...     

Risk factors for and influence of bloodstream infections on mortality: a 1-year prospective study in a Greek intensive-care unit

To determine the incidence, risk factors for, and the influence of bloodstream infections (BSIs) on mortality of patients in intensive-care units (ICUs), prospectively collected data from all patients with a stay in an ICU >48 h, during a 1-year period, were analysed. Of 572 patients, 148 developed a total of 232 BSI episodes (incidence 16.3 episodes/1000 patient-days). Gram-negative organisms with high level of resistance to antibiotics were the most frequently isolated pathogens (157 strains, 67.8%). The severity of illness on admission, as estimated by APACHE II score (OR 1.07, 95% CI 1.04-1.1, P<0.001), the presence of acute respiratory distress syndrome (OR 3.57, 95% CI 1.92-6.64, P<0.001), and a history of diabetes mellitus (OR 2.37, 95% CI 1.36-4.11, P=0.002) were risk factors for the occurrence of BSI whereas the development of an ICU-acquired BSI was an independent risk factor for death (OR 1.76, 95% CI 1.11-2.78, P=0.015). Finally, the severity of organ dysfunction on the day of the first BSI episode, as estimated by SOFA score, and the level of serum albumin, independently affected the outcome (OR 1.44, 95% CI 1.22-1.7, P<0.001 and OR 0.47, 95% CI 0.23-0.97, P=0.04 respectively).     

Impact of intensive care unit-acquired infection on hospital mortality in Japan: A multicenter cohort study

Objectives To elucidate factors associated with hospital mortality in intensive care unit (ICU) patients and to evaluate the impact of ICU-acquired infection on hospital mortality in the context of the drug resistance of pathogens. Methods By using the Japanese Nosocomial Infection Surveillance (JANIS) database, 7,374 patients who were admitted to the 34 participating ICUs between July 2000 and May 2002, were aged 16 years or older, and who stayed in the ICU for 48 to 1,000 hours, did not transfer to another ICU, and did not become infected within 2 days after ICU admission, were followed up until hospital discharge or to Day 180 after ICU discharge. Adjusted hazard ratios (HRs) with the 95% confidence intervals (CIs) for hospital mortality were calculated using Cox’s proportional hazard model. Results After adjusting for sex, age, and severity-of-illness (APACHE II score), a significantly higher HR for hospital mortality was found in ventilator use, central venous catheter use, and ICU-acquired drug-resistant infection, with a significantly lower HR in elective or urgent operations and urinary catheter use. The impact of ICU-acquired infection on hospital mortality was different between drug-susceptible pathogens (HR 1.11,95% CI:0.94–1.31) and drug-resistant pathogens (HR 1.42,95% CI: 1.15–1.77). Conclusions The use of a ventilator or a central venous catheter, and ICU-acquired drug-resistant infection were associated with a high risk of hospital mortality in ICU patients. The potential impact on hospital mortality emphasizes the importance of preventive measures against ICU-acquired infections, especially those caused by drug-resistant pathogens.     

某医院神经内科重症患者医院感染的发生情况及影响因素分析

目的 了解某医院神经内科重症患者医院感染的发生情况,并分析医院感染的影响因素。方法 选择247例神经内科重症患者作为研究对象,根据是否发生医院感染分为医院感染组和非医院感染组,通过回顾性调查和实验室检查,采用logistic回归分析确定神经内科重症患者医院感染发生的影响因素。结果 某医院所有研究对象中,共计43例重症患者发生医院感染,感染率为17.41%,感染部位以呼吸系统（24例,占比55.82%）和泌尿系统（13例,占比30.23%）为主。Logistic回归分析结果发现神经内科重症患者医院感染的独立危险因素包括年龄≥60岁（OR=2.056,95%CI:1.056～4.004）、有意识障碍（OR=3.025,95%CI:1.202～7.615）、使用呼吸机（OR=1.476,95%CI:1.031～2.112）、住院时间≥2周（OR=1.754,95%CI:1.057～2.883）、TP<70g/L（OR=2.469,95%CI:1.132～5.387）和ALB<25g/L（OR=2.312,95%CI:1.130～4.728）（OR=2.312,95%CI:1.130～4.728）（P均<0.05）。结论 某医院神经内科重症患者医院感染的发生率较高,以呼吸系统和泌尿系统感染为主,年龄≥60岁、有意识障碍、使用呼吸机、住院时间≥2周、TP和ALB指标偏低常是独立危险因素。     

综合重症监护病房机械通气患者医院感染分析与预防

目的 了解综合重症监护病房(ICU)机械通气患者医院感染发病率、临床特点、危险因素,探讨有针对性的预防措施.方法 采用主动监测方法,由专职人员每日对综合ICU机械通气≥48 h及撤停机械通气拔除气道导管后48 h内患者进行医院感染监测.结果 医院感染发病率为54.28%,医院感染例次发病率为65.71%,以呼吸机相关性肺炎(VAP)为主;VAP相关因素:实施≥4种侵人性操作比实施3种侵入性操作发生率高,气管切开比气管插管发生率高,差异有统计学意义(P<0.05),先气管插管后切开比先面罩后气管切开发生率高,差异有统计学意义(P<0.01);主要病原菌:革兰阴性杆菌排列前5位为鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、嗜麦芽寡养单胞菌;革兰阳性球菌主要为金黄色葡萄球菌.结论 ICU机械通气患者医院感染发病率高,由多种高危因素引起,需采取综合措施,预防外源性感染,治疗与控制内源性感染.     

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.     

Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system.

OBJECTIVE: To examine the cost associated with targeted surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and the effect of such surveillance on the rate of nosocomial MRSA infection in a community hospital system. DESIGN: A before-and-after study comparing the rate of MRSA infection before (BES) and after (AES) the initiation of expanded surveillance. Cost-effectiveness was calculated as the difference between the cost savings associated with preventing nosocomial MRSA bacteremias and surgical site infections AES and the cost of MRSA cultures and contact isolation for patients colonized with MRSA. SETTING AND PARTICIPANTS: Patients in a 400-bed tertiary-care facility (Roper Hospital) and a 180-bed suburban hospital (St. Francis Hospital), both in Charleston, South Carolina.Interventions. Beginning in September 2001, patients were screened for MRSA colonization upon admission to the intensive care unit and weekly thereafter. In July 2002, surveillance was expanded to include targeted screening of patients admitted to general wards who were at risk of MRSA colonization. Colonized patients were placed in contact isolation. RESULTS: The mean rate of nosocomial MRSA infection decreased at Roper (0.76 cases per 1,000 patient-days BES and 0.45 per 1000 patient-days AES; P = .05) and at St. Francis (0.73 cases per 1,000 patient-days BES and 0.57 cases per 1000 patient-days AES; P=.35). Surveillance was cost-effective, preventing 13 nosocomial MRSA bacteremias and 9 surgical site infections, for a savings of 1,545,762 US dollars. CONCLUSIONS: Targeted surveillance for MRSA colonization was cost-effective and provided substantial benefits by reducing the rate of nosocomial MRSA infections in a community hospital system.     

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.     

神经外科ICU患者医院感染特点及危险因素分析

目的了解神经外科重症监护病房(NICU)的医院感染情况并探讨其危险因素,为医院感染的预防和控制提供理论依据。 方法对2020年1月至2021年12月入住NICU的患者进行医院感染目标性监测,统计医院感染率、器械相关感染发病率、病原菌分布等,利用logistic回归分析筛选医院感染的独立危险因素。 结果123例患者中有30例发生医院感染,感染率为24.39%;呼吸机相关肺炎、导尿管相关尿路感染、血管导管相关感染的发病率分别为15.74%、6.74%、1.76%;医院感染的病原菌以革兰氏阴性菌为主;GCS(3~4分)(OR＝24.016,P＝0.001)、气管切开(OR＝5.438,P＝0.041)和使用呼吸机>7 d(OR＝8.549,P＝0.023)是NICU患者发生医院感染的独立危险因素。 结论NICU医院感染率较高,尤其是呼吸机相关肺炎及导尿管相关尿路感染,应采取针对性的预防控制措施。     

Meticillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis

Data regarding the efficacy of programmes to control meticillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs) are limited. We performed an observational 'before-and-after' study to evaluate the search-and-destroy (S&D) strategy as compared with S&D and isolation (SDI), to control MRSA in a general ICU. S&D included active surveillance, contact precautions and treatment of carriers; in SDI, isolation or cohorting were added. Three phases were identified: period 1 (p1), 1996-1997, before the introduction of programme; period 2 (p2), 1998-2002, with S&D programme; period 3 (p3), 2003-2005, with SDI in a new ICU. During the 10 years of the study we observed 3978 patients; 667, 1995 and 1316 patients in p1, p2 and p3 respectively. The numbers of MRSA-infected patients were 19 in p1, 23 in p2, and 6 in p3. The infection rate was 3.5, 1.7 and 0.7 cases per 1000 patient-days in p1, p2 and p3, respectively; a significant reduction was observed between p1 vs p2 (P=0.024) and p2 vs p3 (P=0.048), although the latter was not confirmed by a segmented regression analysis. The proportion of ICU-acquired MRSA cases was 80%, 77% and 52% during p1, p2 and p3, respectively (P=0.0001 for trend). The proportion of S. aureus isolates resistant to meticillin was 51%, 32% and 23% during p1, p2 and p3, respectively (P<0.0001 for trend). S&D strategy was effective in significantly reducing MRSA infection, transmission rates and proportion of meticillin resistance in an ICU with endemic MRSA. SDI may further enhance S&D efficacy.     

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.     

鲍曼不动杆菌医院感染的危险因素及基因分型研究

目的：了解鲍曼不动杆菌医院感染现状及危险因素，并证实医院内危重病人的监护病房（ICU）是否存在由鲍曼不动杆菌同源性菌株引起的感染。方法；对重庆市4所医院内由鲍曼不动杆菌引发的院内感染140例患者的危险因素进行1：1病例对照研究；同时将近期内某院ICU分离的鲍曼不动杆菌进行M13-PCR扩增分型。结果：研究表明与鲍曼不动杆菌医院感染相关的危险因素依次为病情（OR=8.691）、免疫抑制剂（OR=4.85）、机械通气（OR=3.68）、抗生素使用种类（OR=3.014）。基因分型结果显示从ICU分离的11株鲍曼不动杆菌，其中有5株的基因型完全相同。结论：病情、免疫抑制剂、机械通气和抗生素使用种类为鲍曼不动杆菌医院感染危险因素；院内ICU存在多重耐药鲍曼不动杆菌的感染，应加以控制。     

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。     

失效模式与效应分析法在神经内科ICU医院感染控制中的应用

目的探讨失效模式与效应分析法(failure mode and effects analysis,FMEA)在神经内科ICU医院感染控制中的应用,发现高风险因素,为院感防控提供参考依据。方法根据神经内科ICU临床实际情况,通过FMEA风险评估法对34项医院感染风险事件进行风险评估,按照"二八法则"筛选出风险优先级事件。结果根据每一项风险因素的平均RPN值进行风险排序,按照"二八法则"筛选出风险优先级前6位的事件分别是:本科室医护人员手卫生依从性不到位(平均RPN值=5.6)、导尿管日常维护不到位(平均RPN值=4.17)、多耐患者未有效执行接触隔离措施(平均RPN值=3.80)、物表清洁消毒未有效执行(平均RPN值=3.73)、未严格掌握留置导尿指征(平均RPN值=3.70)、未保持尿液引流系统的密闭性(平均RPN值=3.53)。结论FMEA风险评估法可以发现神经内科ICU医院感染防控中的薄弱环节,为精准化感控措施的制订提供依据。     

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.     

Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit

Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the H?pital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P<0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P<0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries.