基层医院导尿相关尿路感染的危险因素分析

目的 分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天（OR值5．59;95％CI1．94～16．16）、卧床时间≥15天（OR值4．23;95％CI1．85～9．67）、膀胱冲洗（OR值3．63;95％CI1．83～7．23）与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

基层医院导尿相关尿路感染的危险因素分析

目的分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天(OR值5.59;95%CI 1.94～16.16)、卧床时间≥15天(OR值4.23;95%CI 1.85～9.67)、膀胱冲洗(OR值3.63;95%CI 1.83～7.23)与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

Prevalance of and risk factors for hospital-acquired infections in Slovenia-results of the first national survey, 2001

A one-day survey was conducted in all (19) Slovenian acute-care hospitals in October 2001 to estimate the prevalence of all types of hospital-acquired infections (HAIs) and to identify predominant micro-organisms and risk factors. Among 6695 patients surveyed, the prevalence of patients with at least one HAI was 4.6%. The prevalence of urinary tract infections was highest (1.2%), followed by pneumonia (1.0%), surgical wound infection (0.7%), and bloodstream infection (0.3%). In intensive care units (ICUs) the prevalence of patients with at least one HAI was 26.9% and the ratio of episodes of HAI per number of patients was 33.3%. One or more pathogens were identified in 55.8% of HAIs episodes. Among these, the most frequently single isolated micro-organisms were Staphylococcus aureus (18.2%) and Escherichia coli (10.2%). Risk factors for HAI included central intravascular catheter (adjusted odds ratio (OR) 3.2; 95% confidence intervals (CI) 2.1-4.9), peripheral intravascular catheter (adjusted OR 1.7; 95% CI 1.2-2.4), urinary catheter (adjuster OR 2.4; 95% CI 1.6-3.4), and hospitalization in ICUs (adjusted OR 2.5; 95% CI 1.4-4.3). The results provide the first national estimates for Slovenia.     

某综合性教学医院连续3年医院感染横断面调查分析

目的 了解某综合性教学医院的医院感染情况,为该院的院感防控工作提供科学依据。方法 采用床旁调查和查阅病历相结合的方法,对该教学医院连续3年医院感染现患率及相关危险因素进行横断面调查。结果 3年共调查住院患者6766例,实查率为100%;医院感染现患率为2.31%,例次现患率2.56%。呼吸道感染是医院感染最常见的感染部位,占46.81%。年龄35~64岁,65~84岁,留置尿管,机械通气以及留置中央导管是该院医院感染发生的危险因素。革兰氏阴性细菌是该院医院感染的主要病原体,占68.13%。连续3年抗菌药物使用率分别32.12%、35.03%、33.02%;治疗用药送检率分别为 62.75%、54.32%、62.96%。结论 呼吸道感染是该院最常见的医院感染部位,并且应重点监控有侵入性医疗操作的患者,从而降低该院医院感染的发生。     

Variation in nosocomial infection prevalence according to patient care setting:a hospital-wide survey

A study was performed to estimate the prevalence of nosocomial infections (NI) and assess differences between medical care settings in one hospital complex. A seven-day period-prevalence survey was conducted in May 1998 in a large primary and tertiary healthcare centre in Geneva, Switzerland, that included all patients in acute, sub-acute and chronic care settings. Variables included demography, exposure to invasive devices and antibiotics, surgical history, and patients' localization. Overall prevalence of NI was 11.3% (acute, 8.4%; sub-acute, 11.4%; chronic care setting, 16.4%) in the 1928 patients studied, and ranged from 0% in ophthalmology to 23% in critical care units. Odds of infection in sub-acute and chronic care settings were significantly higher than in the acute care setting even after adjustment for case-mix [OR, 2.59; 95% confidence interval (CI(95)) 1.53-4.41; and OR, 2.34; Cl(95)1.38-3.95, respectively]. As a distinct group, patients in the geriatric location (belonging to the sub-acute care setting) showed a significant proportion of urinary (39%) and respiratory (21%) tract infections, contrasting with a relatively low exposure to urinary catheters (6.1%) and orotracheal intubation (0%). In conclusion, sub-acute and chronic care settings are associated with high infection prevalence even after case-mix adjustment. Prevalence studies are an easy surveillance tool that can be exploited further by analysing data according to hospital care settings to identify high-risk areas.     

2型糖尿病患者尿路感染危险因素的Meta分析

目的 明确2型糖尿病患者发生尿路感染的危险因素,为预防尿路感染发生提供依据。方法 计算机检索 Cochrane 图书馆、PubMed、Web of Science、中国知网、万方数据库和维普数据库,搜集自建库至 2020年4月发表的相关文献,利用Endnote X9软件进行文献筛选,Rev Man 5.3 软件进行 meta 分析。结果 共纳入20篇文献,共计87 696例,提取14项危险因素,在年龄（MD = 10.08,95％CI:7.61～12.54）、住院时间（MD = 5.98,95％CI:3.41～8.55）、病程（OR = 0.42,95％CI:0.20～0.90）、空腹血糖（OR = 0.62,95％CI:0.46～0.84）、糖化血红蛋白（SMD = 1.37,95％CI:0.93～1.81）、性别（OR = 0.39,95％CI:0.28～0.55）、抗生素使用（OR = 1.95,95％CI:1.21～3.12）、并发症（OR = 3.01,95％CI:2.40～3.77）、留置尿管（OR = 4.24,95％CI:2.59～6.93）方面有统计学意义（P＜0.05）。结论 年龄、住院时间、病程、空腹血糖、糖化血红蛋白、性别、抗生素使用、并发症、留置尿管是2型糖尿病患者发生尿路感染的危险因素。     

High prevalence of nosocomial infections in rehabilitation units accounted for by urinary tract infections in patients with spinal cord injury

This study (part of the nationwide French prevalence survey of 2001) was organized to investigate the prevalence and risk factors of nosocomial infections (NIs) and the resistant flora in patients hospitalized in rehabilitation units. Two hundred and eighty-six patients were included from two hospitals in the 'Hospices Civils de Lyon' group. Patients were classified into those with and without a spinal cord injury (SCI). Seventy-eight (27.3%) patients had an SCI. They were younger and more often characterized by a low Activity of Daily Life score, bladder incontinence and chronic respiratory disease. Urinary catheterization and mechanical ventilation were more common in these patients. The NI prevalence rate was higher in the SCI group (21.8% vs 4.3%, P<0.00001), particularly for urinary tract infections (UTIs, 19.2% vs 3.4%, P<0.00001). There was a positive relationship between the number of risk factors and NI acquisition. Multi-variate analysis showed that the only independent risk factor for NI acquisition was indwelling urinary catheterization [odds ratio (OR): 11.64, 95% confidence intervals (CI): 2.53-53.65, P=0.002]. Marginally significant factors were chronic kidney or liver disease (OR: 5.84, 95%CI: 0.80-42.68, P=0.082) and SCI (OR: 2.97, 95%CI: 0.61-14.60, P=0.179). The prevalence of antibiotic-resistant micro-organisms was high (nine cases of resistant organisms for 31 infection sites), but there were no differences between the groups. The high rate of NIs, especially UTIs, in SCI patients was not due to an independent effect of SCI but was probably due to the high number of risk factors. These high-risk patients need targeted NI surveillance.     

综合医院医院感染调查

目的：了解住院患者医院感染发生情况,为医院感染监测和控制提供依据.方法：对某综合医院2004年1月～12月68393份出院病例的医院感染监测资料进行调查分析.结果：医院感染总发生率为2.43%;主要发生部位构成比中下呼吸道为最高（59.17%）,其次为泌尿道（7.40%）、胃肠道（4.51%）、皮肤软组织（4.51%）;各临床科室中,肿瘤科、ICU科、干部病房、血液科的医院感染发生率较高;各种类型疾病中,医院感染发生率最高为恶性肿瘤（7.18%）,其次为交界恶性肿瘤（5.97%）、循环系统疾病（3.75%）.结论：下呼吸道是预防医院感染发生的重点部位,应加强对重点科室和重点疾病医院感染的预防.     

Occurrence of hospital infection among interned elderly in a university hospital

OBJECTIVE: Hospital infection is an important cause of morbidity and mortality in the elderly population. The objective of this study was to evaluate the occurrence of hospital infection and risk factors associated with it. METHODS: This is a prospective study of a sample of 332 elderly people, 60 years and older, interned in a university hospital, between September 1999 and February 2000. Sample size was calculated according to the Fisher and Belle formula, with a confidence interval of 0.95%, from a total of 760 elderly patients interned, in proportion to the number of patients present in each in-patient unit, in the 1997. Criteria for defining hospital infection were those established by the Center for Diseases and Prevention Control. Odds ratio and logistic regression were utilized for statistical analysis of the data. RESULTS: The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%). The period of hospitalization of patients who did have hospital infections was 6.9 days, while those who had hospital infections were hospitalized for 15.9 days (p<0.05). Mortality rate among hospitalized patients was 9.6% and the rate of lethality among patients with hospital infection was 22.9% (p<0.05). Risk factors found for hospital infection were cholangiography (odds ratio (OR) =46.4, confidence interval 95% (CI95%) =4.4-485); diabetes mellitus (OR=9.9, CI 95% =4.4-22.3); chronic obstructive pulmonary disease (OR=8.3, CI 95% =2.9-23.7); urinary catheters (OR=5, CI 95% =2.7-11.8); hospitalization with community infection (OR=3.9, CI 95% =1.7-8.9) and mechanic ventilation (OR=3.8, CI 95% =1.9-6.3). CONCLUSIONS: Hospital infection presented elevated incidence and lethality and it increased the period of hospitalization among the elderly studied.     

Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients

A prospective cohort study was performed to evaluate the influence of catheter manipulations on catheter associated bloodstream infection (CABSI) in neonates. Neonates admitted between 1 November 1993 and 31 October 1994 at the neonatal intensive care unit of a university hospital were included in the study. Seventeen episodes of CABSI occurred in 357 central catheters over a period of 3470 catheter-days, with a cumulative incidence of 4.7/100 catheters and an incidence density of 4.9/1000 catheter-days. Patient and catheter-related risk factors independently associated with CABSI were: catheter hub colonization (odds ratio [OR] = 32.6, 95% confidence interval [95% CI] = 4.3-249), extremely low weight (相似文献   

Does catheter-associated urinary tract infection increase mortality in critically ill patients?

OBJECTIVE: To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors. DESIGN: Nested case-control study in a multicenter cohort (the OutcomeRea database). SETTING: Twelve French medical or surgical ICUs. METHODS: All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age (+/- 10 years), SAPS (Simplified Acute Physiology Score) II score (+/- 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression. RESULTS: Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P=.02); the same was true for crude hospital mortality rates (43% vs 30%, P<.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P=.19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P=.64). CONCLUSION: After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.     

重症监护病房医院感染流行病学调查及预防

目的：探讨重症监护病房（ICU）医院感染流行病学的特征和相关因素，为预防控制医院感染提供依据，方法：对2002年1月～2004年12月收治的319例ICU患者进行医院感染回顾性调查。结果：ICU医院感染发生率17，24％，常见感染部位前5位的是下呼吸道感染50．9l％、上呼吸道感染20．00％、泌尿道感染9．09r‰、胃肠遭感染7．27％、血液感染5，45％；分离出病原菌29株，革兰阴性菌占62．07％；居前3位的是假单胞菌31．03％、金黄色葡萄球菌20．69％、不动杆菌17，24％；医院感染的危险因素是使用呼吸机、泌尿道插管、动静脉插管、留ICU时间长。结论：ICU医院感染发生率高；病原菌以革兰阴性菌为主；应针对相关危险因索和常见医院感染进行预防。     

医院感染横断面研究报告

目的 探讨横断面调查的优势，评价日常监测资料的准确性。方法 采用横断面调查方法，床旁调查和病历调查相结合，调查我院1d的医院感染现患率。结果 调查住院患者1137人，现患率为7．04％，例次现患率为7．83％；重症监护病房的现患率最高为33．33％；下呼吸道感染占28．09％，泌尿道感染占14．60％，手术部位感染占13．49％；年龄＜2岁和＞60岁、泌尿道插管、动静脉插管、免疫抑制剂、激素、化疗、手术切口污染程度是医院感染的高危因素；日抗菌药物使用率为59．3％。结论 横断面调查简单、方便，节省人力，资料更准确。     

National prevalence of nosocomial infections. Cuba 2004

In 1983 Cuba instituted its first Nosocomial Infection (NI) Control and Prevention National Program with a continuous surveillance system. We undertook the first NI prevalence study in 1997 in an attempt to compare our national findings with international results. A second prevalence study with a randomised design was undertaken between 24 and 29 May 2004. The overall rate of NI was 7.3% (284/4240; 95% CI: 5.9-7.4), and 6.7% of patients were found to have at least one NI. The highest rates were found in intensive care, intermediate care and burn units. The most frequent NI was surgical site infection, whereas the number of urinary tract infections remained low. Microbiological culture was obtained in nearly 53% of infections; Staphylococcus aureus and Pseudomonas spp. were the most commonly isolated pathogens. Cephalosporins and aminoglycosides were the antibiotics most often used in the treatment of NIs. The risk factors for NIs found in the Cuban studies were similar to international reports.     

2010-2012年沈阳市某医院医院感染现患率调查与分析

目的了解沈阳市某医院医院感染发生情况和趋势,为针对性地预防医院感染提供依据。方法采用横断面调查的方法,于2010-2012年对该院某日0-24时所有住院患者进行调查。结果该院3年医院感染现患率为4．59％-6．05％,显著高于当月医院感染发病率（1．50％-2．10％）。医院感染感染部位以呼吸道为主,其次为泌尿道等。抗菌药物使用率为51．63％-58．91％,治疗性使用抗菌药物病原学送检率为20．37％-23．07％。结论开展医院感染现患率调查,有利于了解医院感染现状和提高日常监测工作质量。同时应加强重点部门、重点部位的目标性监测与管理,加强抗菌药物的监控与管理,提高病原学送检率,正确、合理地使用抗菌药物。     

假丝酵母菌致医院感染的危险因素

目的探讨某院假丝酵母菌所致医院感染的危险因素。方法选取该院2011年1月-2013年10月64例假丝酵母菌医院感染患者作为病例组,同期未发生医院感染的64例患者作为对照组,对两组患者的病历资料进行分析。结果医院感染假丝酵母菌以白假丝酵母菌（68.75%）为主,其次为热带假丝酵母菌（15.62%）、光滑假丝酵母菌（9.38%）和克柔假丝酵母菌（6.25%）;感染部位以呼吸道（67.19%）为主,其次为泌尿道（18.75%）、消化道（10.94%）等。单因素分析表明：年龄、住院时间、糖尿病、恶性肿瘤等13个因素是假丝酵母菌医院感染危险因素;多因素logistic回归分析显示,年龄（OR 95% CI：2.57~33.67）、住院时间（OR 95% CI：2.17~25.37）、恶性肿瘤（OR 95% CI：1.04~15.23）、化学治疗（OR 95% CI：1.76~20.63）、使用呼吸机（OR 95% CI：4.67~96.37）是假丝酵母菌医院感染的重要危险因素。结论假丝酵母菌医院感染的危险因素较为复杂,应充分考虑并针对危险因素采取防控措施,降低假丝酵母菌医院感染的发生率。     

医院感染发生的横断面研究

目的 了解医院感染的现状及抗菌药物的使用情况,更加有效地预防和控制医院感染的发生和流行,进一步提高医院管理工作质量,降低医院感染发生率方法 采用横断面研究方法,选取某一时点的所有住院患者,以床旁调查与病案调查相结合,填写统一的个案调查表,再用SPSS11.5统计软件进行数据分析结果 共调查住院患者360人,发生医院感染12例,发生率为3.33%;医院感染发生较高的部位依次为下呼吸道、上呼吸道、泌尿道和手术切口;医院感染相关因素中,不同年龄组医院感染发生率的差别具有统计学意义（χ2=5.708,P＜0.05）;是否采取相关导管操作的医院感染发生率的差别具有统计学意义（χ2=5.999,P＜0.05）;是否为手术操作医院感染发生率的差别具有统计学意义（χ2=4.793,P＜0.05）;12例医院感染病例中7例做了病原学检查,病原体送检率为58.33%,检出病原体主要是G-菌;调查360例中,使用抗菌药物184例,抗菌药物使用率为51.11%结论 通过医院感染发生的横断面研究,能及时发现存在问题,找出医院感染控制的薄弱环节和感染源,为有的放矢制定医院感染预防与控制措施提供可靠依据.     

Prevalence of hospital-acquired infections in a home care setting

The aim of this point-prevalence study was to determine the prevalence of hospital-acquired infections (HAIs) by site of infection and the associated risk factors in a 'hospital at home' setting in Paris. All patients undergoing a care procedure with a risk of infection and who had been in home care for more than 48 h on the day of the survey (5 June 2000) were enrolled. A standard questionnaire was completed by nurses, midwives and family doctors. Overall, 6.1% of patients had at least one HAI [95% confidence intervals (CI): 3.7-8.5%] and there were 6.3 infections per 100 patients (infections/infected patients ratio: 1.04). The most common site of infection was the urinary tract (50.0%), followed by the skin (37.9%). Infection rates were 3.2% and 2.4%, respectively. Escherichia coli (29.4%), Staphylococcus aureus (29.4%) and Enterococcus spp. (17.6%) were the predominant micro-organisms. In multivariate analysis, the most significant independent risk factor was the presence of a urinary catheter (odds ratio=15.9, 95%CI: 6.3-40.1, P<0.0001). In conclusion, this prevalence study has provided a better understanding of the types of patient receiving 'hospital at home' care, an insight into risk factors for HAIs in home care, and a basis for improving surveillance and prevention.     

医院感染现患率调查分析

目的了解我院医院感染现患情况. 方法采用横断面调查的方法,对2004年5月17日的住院患者进行医院感染现患率调查. 结果调查住院患者1 012人,医院感染现患率为3.16%,例次现患率为3.36%;危重医学科(外科ICU)现患率最高为60%;下呼吸道感染占50%;抗菌药物使用率为44.7%;年龄＜2岁或＞60岁、动静脉插管、呼吸机、气管切开、放疗等是医院感染的高危因素. 结论医院感染现患率调查快速、有效,能够为有效开展医院感染目标性监测提供依据.