重症医学科医院感染监测及危险因素

目的调查分析重症医学科（ICU）医院感染率、病原菌检出分布及危险因素，为持续质量改进和提高ICU医院感染管理水平提供科学依据。 方法选取2014年1月至2015年12月苏州市吴江区第一人民医院ICU住院患者进行目标性监测，应用Logistic回归分析ICU医院感染危险因素。 结果共收集病例981例，发生医院感染100例和104例次，总体感染及总体例次感染率分别为10.19%、10.60%；与2014年比较，2015年医院感染率、例次感染率、日医院感染率和日例次感染率均有不同程度下降，特别是呼吸机相关肺炎感染发病率显著下降5.78‰；2014年和2015年医院感染均以呼吸机相关性肺炎居首位，占比均≥55%；单因素分析显示，年龄、使用呼吸机、留置导尿管、抗菌药物使用和免疫抑制剂使用等与医院感染发生相关（P<0.05）；Logistic回归分析显示，使用呼吸机、抗菌药物使用和免疫抑制剂使用是ICU医院感染的独立危险因素（OR=3.692，95%CI：3.829~7.027，P=0.012；OR=1.756，95%CI：1.191~2.590，P=0.000；OR=3.457，95%CI：2.019~5.971，P=0.000）；ICU医院感染病原菌以革兰阴性菌为主，鲍曼不动杆菌平均检出率最高，但与2014年比较，2015年该菌检出率降低了10.89%。 结论与2014年比较，2015年ICU医院感染管理水平和质量有了持续改进和提高；此外，严格掌握抗菌药物使用指征，尽量避免免疫抑制剂使用，能有效降低感染发生率，特别对老年患者更为显著。

Surveillance of nosocomial infection and analysis of risk factors in an intensive care unit

ObjectiveTo investigate the nosocomial infection rate, pathogens and underlying risk factors in an intensive care unit (ICU) and provide evidence to improve quality of infection control. MethodsSurveillance was conducted in ICU patients from January 2014 to December 2015. Underlying risk factors of nosocomial infection was analyzed by binary logistic regression. ResultsA total of 981 patients was collected. 104 nosocomial infections were recorded in 100 patients. The overall incidence of nosocomial infection and infection rate were 10.19% and 10.60% respectively. Compared with the data in 2014, a trend of decrease in nosocomial infection incidence and infection rate was concluded. In particular, the incidence of ventilator-associated pneumonia was significantly reduced by 5.78 ‰. Both in 2014 and 2015, ventilator-associated pneumonia was the primary nosocomial infection type, accounting for more than 55% nosocomial infections. Chi-square test of underlying factors of nosocomial infection indicated that, age, invasive ventilation, insertion of urinary catheter and use of antibiotics are associated risk factors for nosocomial infection in ICU (P<0.05). Non-conditional logistic regression multivariate analysis showed that, the use of ventilator and antibiotics were independent risk factors for nosocomial infection (OR=3.692, 95%CI: 3.829-7.027, P=0.012; OR=1.756, 95%CI: 1.191-2.590, P=0.000; OR=3.457, 95%CI: 2.019-5.971, P=0.000). Gram negative bacterium was still the major nosocomial pathogen in ICU. The primary isolated gram negative bacteria was Acinetobacter baumannii, but with a decreased isolation rate of 10.89% in 2015 compared with 2014. ConculsionManagement and quality control of nosocomial infection in ICU had improved in 2015. At the same time, reasonable antibiotic stewardship could reduce nosocomial infection, particular for geriatric patients.