382例医院感染患者现状分析与对策

目的：分析医院感染的发生情况,以便采取针对性措施,有效预防与控制医院感染。方法：对2012年在我院发生医院感染的382例患者的临床资料进行回顾性调查。结果：不同患者年龄、住院时间、原发疾病、侵入性操作等的医院感染发生率不同,年龄60岁以上人群占58.64%,住院7～30天占51.31%,颅脑疾病占19.64%,接受侵入性操作占66.23%。感染部位以呼吸道占首位,占70.68%。检出病原菌407株,主要为条件致病菌,以革兰氏阴性杆菌为主,占61.18%。结论：年龄大、住院时间较长（7～30天）、原发疾病重、接受侵入性操作的患者发生医院感染的可能性更大,重点关注以下人群,采取积极的预防与控制措施,可有效预防医院感染的发生。     

泌尿道来源大肠埃希菌继发血流感染的危险因素分析

目的了解住院患者泌尿道来源大肠埃希菌(ECO)继发血流感染情况,探讨泌尿道来源ECO继发血流感染的危险因素及此种现象的分离率变迁情况,为更好地预防和控制泌尿道来源ECO继发血流感染和流行提供科学依据。方法收集2011~2013年由泌尿道来源ECO继发血流感染的住院患者82例,与同期尿培养为ECO但无血流感染患者82例进行单因素χ2检验及多因素Logistic回归分析。分别计算2011~2013年各年及不同科室泌尿道来源ECO的分离率,绘制成表格进行分析得出分离率变迁情况。结果肾功能不全、尿管留置、发热、尿常规白细胞增多在试验组和阴性组中差异具有统计学意义(P0.05),属于危险因素。其中尿管留置、发热、尿常规白细胞增多具有显著关系,属于独立危险因素。结论泌尿道来源ECO继发血流感染为多因素所致,主要与尿管留置、发热、尿常规白细胞增多有关,对存在上述危险因素的患者应尽量减少侵入性操作(如泌尿插管等),严格无菌及消毒制度,密切关注临床症状及其实验室检查指标。通过分离率的图表发现,泌尿道来源ECO继发血流感染的现象明显升高,并在该院呈扩散趋势。     

Biotyping of coagulase-negative staphylococci. 108 isolates from nosocomial bloodstream infections

Using simple, readily available typing methods, we evaluated 108 strains of coagulase-negative staphylococci that were causally related to bloodstream infections: 95% (103 of 108) of the isolates were identified as Staphylococcus epidermidis and were divided into 18 biotypes by API Staph-Trac. A single biotype (biotype A, 6606113) accounted for greater than 50% of the isolates of S. epidermidis. Biotype A was further divided into seven subtypes by slime production and synergistic hemolysis; however, 66% of the isolates in biotype A remained in two major subtypes, 1a (strongly slime-positive and synergistic hemolysis-positive) and 2a (strongly slime-positive and synergistic hemolysis-negative). The addition of the antibiotype further separated the isolates into individual strains or into small groups of organisms. A significant correlation was noted between synergistic hemolysis and the three most resistant antibiotypes (p = 4.2 X 10(-5); OR = 5.8; CI95, 2.2-15.2). Each biotype, subtype, and antibiotype was further divided into multiple unique strains by plasmid pattern analysis. In most clinical situations the combination of API Staph-Trac, antibiotic profile, slime production, and synergistic hemolysis provides adequate strain discrimination. Plasmid pattern analysis adds important information in specific clinical situations and may be invaluable for epidemiologic investigations.     

Risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-beta-lactamase in two tertiary-care teaching hospitals

OBJECTIVES: To assess risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo-beta-lactamase (MBL-PA) in two teaching hospitals where horizontal dissemination has been demonstrated. METHODS: A case-control study was performed in both hospitals (assigned as hospital 1 and 2). Cases were patients with MBL-PA infections and controls were those with non-MBL-PA infections. Multivariate analysis was performed to identify independent risk factors. RESULTS: A total of 86 cases and 212 controls were included in the study. A logistic regression model showed that exposure to beta-lactams [odds ratio (OR) 3.21; 95% confidence interval (CI) 1.74-5.93] or fluoroquinolones (OR 3.50; 95% CI 1.46-8.37) was associated with MBL-PA infections. Other independent risk factors were neurological disease (OR 3.00; 95% CI 1.61-5.58), urinary tract infection (OR 2.48; 95% CI 1.21-5.09) and renal failure (OR 2.29; 95% CI 1.13-4.65). Admission to hospital 1 (OR 5.97; 95% CI 3.45-14.09) and intensive care unit stay (OR 2.07; 95% CI 1.46-3.96) were also associated with increased risk for MBL-PA infections. CONCLUSIONS: beta-Lactam exposure is an important risk factor for MBL-PA infections even in a setting where patient-to-patient transmission plays a major role in the spread of the isolates. Other risk factors deserve further investigation, particularly exposure to fluoroquinolones.     

医院MRSA感染危险因素分析

目的分析医院耐甲氧西林金黄色葡萄球菌(MRSA)感染危险的因素,以便采取有效措施降低感染率。方法对各科室送检标本实施MRSA菌株分离,然后采用1∶1成组病例对照选取非医院MRSA感染患者60例,并与60例医院MRSA感染患者料进行单因素分析、多因素研究分析。结果单因素分析结果显示高龄、住院时间长、抗生素使用超过2种、广谱抗菌药使用时间超过7 d、侵入性操作超过2项等因素与医院MRSA感染有关。多因素分析结果显示医院MRSA感染的危险因素主要有住院时间长、侵入性操作超过2项、广谱抗菌药使用时间超过7 d和抗生素使用超过2种。结论侵入性操作、长时间住院、光谱抗菌药长时间使用和抗菌药的不合理应用是医院MRSA感染的危险因素。     

Risk factors for nosocomial infections and/or sepsis in adult burns patients: An integrative review

BackgroundIn comparison to general trauma patients, loss of skin barrier amongst the burns cohort predisposes them to a higher risk of nosocomial infections and sepsis, and this often leads to unfavourable morbidity and mortality outcomes.PurposeThis integrative review aimed to explore existing literature to identify risk factors related to nosocomial infections and/or sepsis in adult burns patients following hospital admission.MethodsElectronic searches for journals published between 2007 and 2021 were performed in CINAHL, Scopus and Medline, and key journals were hand-searched. Inclusion criteria was: (1) peer-reviewed, primary studies; (2) qualitative, quantitative or mixed-methods studies; (3) study participants had sustained burns-related injury and developed nosocomial infections and/or sepsis during the course of hospitalisation. Studies were appraised using the Critical Appraisal Skill Program checklists.Results15 studies ranging from ‘poor’ to ‘fair’ to ‘moderate’ quality were included in the final review. Patient factors that contributed to the development of nosocomial infections and/ or sepsis included: (1) Full thickness burns; (2) age; (3) % Total Burns Surface Area; and (4) Herpes Simplex Virus activation. Several provider-system risk factors were identified by ‘poor’ quality studies and further research is required to substantiate those findings.DiscussionFindings remained inconclusive due to the lack of ‘good’ quality studies however, there was an overemphasis on patient-related risk factors instead of healthcare workers or the system. Future research may focus on activation of the latest infection prevention strategies and early enforcement of care bundles. Through identification of related risk factors, it may reduce the incidence of nosocomial infection and/or sepsis post-burns.     

多重耐药鲍曼不动杆菌血流感染的危险因素和预后分析

目的探讨多重耐药(MDR)鲍曼不动杆菌血流感染的危险因素及其对患者预后的影响。方法采用病例对照的研究方法,回顾性收集昆明医科大学第一附属医院2013-2018年鲍曼不动杆菌血流感染患者142例(142株),以MDR鲍曼不动杆菌血流感染111例(111株)为观察组,非多重耐药(NMDR)鲍曼不动杆菌血流感染31例(31株)为对照组,进行血流感染的危险因素分析;按预后分为预后不良组81例和好转组61例,进行预后的危险因素分析。结果鲍曼不动杆菌对常用抗菌药物耐药率高,除替加环素外,MDR鲍曼不动杆菌组的耐药率均高于NMDR鲍曼不动杆菌组,差异均有统计学意义(P<0.05)。MDR鲍曼不动杆菌组病死率高于NMDR鲍曼不动杆菌组(43.2%比3.2%),差异有统计学意义(P<0.05);MDR鲍曼不动杆菌组预后不良发生率高于NMDR组(69.4%比12.9%),差异有统计学意义(P<0.05);多因素分析结果显示呼吸衰竭、初始抗感染治疗不当是MDR鲍曼不动杆菌血流感染的独立危险因素。呼吸衰竭、使用导尿管、初始抗感染治疗不当、肺部感染是影响鲍曼不动杆菌血流感染预后的独立危险因素。结论MDR鲍曼不动杆菌血流感染所致的病死率较NMDR鲍曼不动杆菌病死率高。呼吸衰竭、初始抗感染治疗不当是MDR鲍曼不动杆菌血流感染的独立危险因素。呼吸衰竭、使用导尿管、初始抗感染治疗不当、肺部感染是影响鲍曼不动杆菌血流感染预后的独立危险因素。     

Risk factors for nosocomial pneumonia in critically ill trauma patients

OBJECTIVE: To determine risk factors for nosocomial pneumonia in critically ill trauma patients. DESIGN: Prospective cohort study. SETTING: The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital. PATIENTS: All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and October 1996. INTERVENTIONS: A comparison of data recorded at the time of ICU admission and during the clinical evolution in patients with (n = 23) and without (n = 80) nosocomial pneumonia was made. Data referred mainly to possible risk factors were recorded; they also included factors related to pneumonia etiology and evolutive factors. Predictors of nosocomial pneumonia were assessed by logistic regression analysis. MEASUREMENTS AND MAIN RESULTS: The presence of significant growth on quantitative cultures of the protected specimen brush (> or = 103 colony forming units/mL) was required to accept pneumonia as microbiologically proven, as well as the concurrence of a cohort of clinical and radiologic signs. Twenty-three (22.3%) patients developed nosocomial pneumonia. The mean age of these patients was 41.7 yrs; 18 of them (78.3%) were men. The microorganisms isolated in significant concentrations were Acinetobacter baumanii (ten cases), Staphylococcus aureus (11 cases), Pseudomonas aeruginosa (five cases), Haemophilus influenzae (two cases), and Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Enterococcus spp., Enterobacter spp., coagulase-negative Staphylococcus, and Streptococcus intermedius (one case each one). Risk factors for pneumonia by univariate analysis included nasogastric tube; continuous enteral feeding; prolonged mechanical ventilation (>1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. The mortality rate was 43.5% (10 of 23) in the nosocomial pneumonia group and 18.8% in patients without nosocomial pneumonia (p =.02). Also, the mean stay in the ICU, the therapeutic charge (measured with total and mean punctuation of the Therapeutic Intervention Scoring System) and the complications, infectious and noninfectious, of the clinical evolution were significantly more frequent in patients with nosocomial pneumonia than in those without pneumonia (p <.05). In the multivariate analysis, continuous enteral feeding, craniotomy, prolonged mechanical ventilation (>24 hrs), use of positive end-expiratory pressure, and corticotherapy were independent predictors of nosocomial pneumonia. CONCLUSIONS: It seems that factors related to the patient's clinical course, rather than variables registered on the first days of ICU admission, are those that would exert an influence on the development of nosocomial pneumonia in critically ill trauma patients. In this way, from our point of view, in our study the main risk factors are the use of prolonged mechanical ventilation (>4 hrs) and positive end-expiratory pressure. At the same time, we can conclude that the reduction of this infection incidence could decrease the mean stay in the ICU, the therapeutic charge, and the prognosis in terms of mortality and morbidity.     

Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters

OBJECTIVES: To examine the effectiveness of antimicrobial-impregnated and heparin-bonded catheters relative to standard central venous catheters in lessening catheter-related bloodstream infections. DATA SOURCES: Articles were identified by computer-assisted searching. STUDY SELECTION: Studies were eliminated from further consideration if they did not contain original data relevant to lessening catheter-related bloodstream infections, were nonrandomized or uncontrolled, described subjects <17 yrs of age, or used animal subjects. DATA ABSTRACTION: From each eligible article, we abstracted the following: a) citation; b) type of control; c) study setting; d) type of experimental catheter; e) catheter-specific complications; f) total numbers of patients and catheters; g) number of experimental catheters used that resulted in a catheter-related bloodstream infection; h) number of control catheters used that resulted in a catheter-related bloodstream infection; i) number of experimental catheters used without catheter-related bloodstream infections; and j) number of control catheters used without infections. We also recorded the duration of catheter use and the types of microbes cultured in association with the catheters and with catheter-related bloodstream infections. DATA SYNTHESIS: Eleven eligible studies were identified. Using meta-analysis, we showed that antimicrobial-impregnated and heparin-bonded central venous catheters significantly decreased catheter-related bloodstream infections by 2.32% (95% confidence interval, 1.04% to 3.61%). CONCLUSIONS: The modest additional cost for the use of these catheters relative to the considerable cost of treating even a single bloodstream infection makes their use cost-effective.     

Risk factors for nosocomial pneumonia. Focus on prophylaxis.

Despite an increased understanding of the pathogenesis of NP and advances in diagnosis and treatment, the risk, cost, morbidity, and mortality of NP remain unacceptably high. This article has identified strategic areas for primary and secondary prophylaxis that are simple and cost-effective. Realizing that the pathogenesis of NP requires bacterial colonization and the subsequent entry of these bacteria into the lower respiratory tree helps highlight the role of cross-infection and the importance of standard infection control procedures. Similarly the role of sedation and devices as risk factors can be reduced by minimizing the duration and intensity of sedation and length of exposure to invasive devices. Additional low-cost interventions that have been shown to be effective in preventing NP are the positioning of patients in a semirecumbent position and the appropriate use of enteral feeding, antibiotics, and selected medical devices. Prophylaxis of NP and VAP is carried out best by a multidisciplinary management team comprised of physicians (critical care, pulmonary medicine, infectious diseases, and primary care), critical care and infection control nurses, and respiratory therapists, even though this approach may result in decreased professional autonomy and freedom. This group should review the current guidelines, pathways, and standards for short-term and long-term prophylaxis of NP and VAP, then integrate them into and monitor their use for routine patient care. The risk factors and prophylaxis strategies for NP discussed in this article apply primarily to patients in acute care facilities, but also are relevant to alternative health care settings as well as the care of ill patients in ambulatory settings. The routine use of effective team policies for prophylaxis needs to be monitored by the Joint Commission for the Accreditation of Health Care or other agencies. Research to delineate the most effective and feasible strategies for prophylaxis NP has been compromised by insufficient funding and lack of adequate, randomized multicenter studies to enable generalizability of results. Effective strategies for prophylaxis have not been disseminated widely or implemented in hospitals. Successful short-term and long-term strategies for prophylaxis must be evaluated and implemented by a team of physicians, nurses, and respiratory therapists. More than 100 years ago, Sir William Osler warned health care providers, "Remember how much you don't know." The authors would add that clinicians have acquired significant knowledge about risk factors and prophylaxis of NP in the 1980s and 1990s, but prophylaxis as a theory rather than an action. If the tree has not been planted, the time is now.     

Risk factors for nosocomial pneumonia in critically ill trauma patients

Nosocomial pneumonia is the most common pulmonary complication in trauma patients and the leading cause of death in nosocomial infections. A comprehensive review of pneumonia studies is provided. The Centers for Disease Control's nosocomial pneumonia pathogenesis model is reviewed and was used to guide the selection of risk factors evaluated in this study. The purposes of this research were to identify underlying dimensions (factors) of variables that increase the risk of nosocomial pneumonia and to identify predictors of nosocomial pneumonia in critically ill trauma patients.     

Clostridial bloodstream infections

In a ten-year review at a large community teaching hospital clostridia accounted for less than 1% of all positive bloodstream isolates (26 episodes in 25 patients). All but one of the isolates were clinically significant. Twenty-two patients (88%) had a serious underlying medical condition, and 17 of the episodes (65%) were associated with a bowel source; twelve patients (48%) died of their infection. Clostridial bloodstream infections are particularly clinically significant in patients with serious underlying disease.     

Multidrug-resistant Proteus mirabilis bloodstream infections: risk factors and outcomes

Our aims were to identify (i) risk factors associated with the acquisition of multidrug-resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis isolates responsible for bloodstream infections (BSIs) and (ii) the impact on mortality of such infections. Risk factors for acquiring MDR P. mirabilis BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and nonsurvivors in a cohort study. The population consisted of 99 adult inpatients with P. mirabilis BSIs identified by our laboratory over an 11-year period (1999 to 2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio [OR], 9.78; 95% confidence interval [CI], 1.94 to 49.16), previous therapy with fluoroquinolones (OR, 5.52; 95% CI, 1.30 to 23.43) or oxyimino-cephalosporins (OR, 4.72; 95% CI, 1.31 to 16.99), urinary catheterization (OR, 3.89; 95% CI, 1.50 to 10.09), and previous hospitalization (OR, 2.68; 95% CI, 10.4 to 6.89). Patients with MDR P. mirabilis BSIs received inadequate initial antimicrobial therapy (IIAT, i.e., treatment with drugs to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day mortality was associated with septic shock at BSI onset (OR, 12.97; 95% CI, 32.2 to 52.23), P. mirabilis isolates that were MDR (OR, 6.62; 95% CI, 16.4 to 26.68), and IIAT (OR, 9.85; 95% CI, 26.7 to 36.25), the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify P. mirabilis BSIs likely to be MDR, thereby reducing the risk of IIAT--a major risk factor for mortality in these cases--and facilitating the prompt implementation of appropriate infection control measures.     

极低出生体重儿院内感染状况及原因分析

目的探讨极低出生体重儿（verylowbirthweightinfant,VLBWI）院内感染特征,分析感染发生的可能危险因素,以便采取针对性的预防对策。方法回顾性调查2012年1～6月本院重症监护病房58例VLBWI感染发生情况、感染特征及感染发生的原因。结果58例WLBWI住院期间院内感染发生率为60．34％,感染病原菌主要为革兰氏阳性菌（占88．47％）,以肺部感染（占82．90％）为主;感染时间主要在出生后21d内。机械通气、经外周静脉置管术（peripherallvinsertedcentralcatheter,PICC）、阿氏评分≤7分、使用氟康唑及胎膜早破的VLBWI感染率较高（均P〈o．05）。结论VLBWI感染发生率较高,主要为肺部感染,发生时间主要集中在出生后21d内;机械通气、PICC、阿氏评分低、胎膜早破等是VLBWI感染的主要因素。应加强VLBWI出生后3W内的感染控制,尽量减少对患儿的侵入性操作,合理使用抗生素,同时加强围生期保健,降低早产发生率。     

碳青霉烯耐药肺炎克雷伯菌血流感染的危险因素分析

目的 探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染患者的多重危险因素,为临床诊疗和预防提供依据.方法 回顾性分析华北理工大学附属医院2013年1月至2020年12月确诊且病例资料完整的CRKP血流感染患者的临床资料(病例组),以同期感染碳青霉烯类敏感肺炎克雷伯菌(CSKP)的患者作为对照组,使用SPSS 23.0软...     

Predicting nosocomial bloodstream infections using surrogate markers of injury severity: clinical and methodological perspectives

BACKGROUND: Injury severity indices are numerical scores that are utilized to predict nosocomial bloodstream infections (BSI) in critically ill patients. However, surrogate markers of injury severity (SMIS) may be more clinically meaningful than these commonly used numerical injury severity indices with respect to the control and prevention of nosocomial BSI. OBJECTIVE: The purpose of this study was to demonstrate the clinical and research implications of using the SMIS in predicting nosocomial BSI. METHOD: A prospective nonexperimental cohort study was conducted on 361 critically ill trauma patients. Three logistic regression models were examined for their clinical relevance and statistical parsimony. The first model included the Injury Severity Score (ISS) and 5 other independent predictors, and excluded the SMIS. The second model included all study variables. The third model excluded the ISS. RESULTS: The analysis suggested that number of blood units transfused, number of central venous catheters inserted, and use of chest tube(s) were the SMIS. The ISS was found to be an independent predictor of nosocomial BSI only when the SMIS were not included in the model. The model that included the SMIS and excluded the ISS explained the highest variance in nosocomial BSI and had the best negative predictive value (93%). DISCUSSION: Clinicians can use knowledge of SMIS to develop interventions that minimize the risk of nosocomial BSI. Hence, the SMIS can serve not only as a prediction tool but also as a way to enhance control and prevention strategies for BSI.     

Nosocomial Non-fermentative gram negative bacteria bloodstream infections in children; Risk factors and clinical outcomes of carbapenem resistance

IntroductionNon-fermentative Gram-negative bacterias (NFGNBs) are a major cause of life threatening infections in hospitalized children. In this study, we aimed to evaluate the demographic and clinical characteristics of NFGNBs infections and identify the risk factors and outcomes of bloodstream infections (BSIs) caused by carbapenem-resistant (CR) NFGNBs infections.MethodsA retrospective cohort was designed to evaluate the patients with a BSI caused by NFGNBs between in January 2014 and December 2017.ResultsA total of 131 episodes from 115 patients were evaluated. The mean age of the patients was 4.79±(4.74) year. The most commonly isolated NFGNBs species was Acinetobacter spp. (35.9%), Pseudomonas spp. (34.4%), and Stenotrophomonas maltophilia (13%). The rate of carbapenem-resistance was 38.2% in Acinetobacter spp. and 26.6% in Pseudomonas spp. The comparison of CR group with carbapenem-susceptible (CS) group showed statistical significance for the length of hospital stay prior to onset of infection and total hospital stay (P values were 0.001, 0.008). Based on the univariate analysis, requirement of mechanical ventilation, central venous catheter, nasogastric tube, Foley catheter, severe neutropenia (<100/mm3), prolonged neutropenia (≥14 days), prior intensive care unit admission and prior antimicrobial treatment (carbapenems, colistin, glycopeptide) were more common in carbapenem-resistant NFGNBs infections (P values are 0.001, 0.012, 0.000, 0.005, 0.042, 0.027, 0.007, 0.007). In patients with NFGNBs infections 14-day and 30-day mortality rates were %16.8 and 21.4%.ConclusionCR infections were more common in children with prolonged and severe neutropenia. Prior antimicrobial use and intensive care unit admission were more common in CR infections.