多中心ICU获得性下呼吸道感染监测报告

目的了解重症监护室(ICU)获得性下呼吸道感染情况及病原体分布特点,为采取预防控制措施和科学诊治患者提供依据。方法采用回顾性调查,收集某省32所医院ICU2013年全年医院感染目标性监测资料。结果 32所医院,ICU获得性下呼吸道感染发病率为5.79%,呼吸机使用率为31.25%,呼吸机相关性肺炎(VAP)发病率为26.93‰;呼吸机使用率与VAP发病率相关性分析(r=0.160,P=0.380),差异无统计学意义,两者无直线相关关系。共检出阳性菌株1 593株,其中以革兰阴性菌居多(1 207株,占75.77%),其次为革兰阳性菌(290株,占18.21%),真菌(94株,占5.90%),肺炎支原体和其他病原体(各1株,占0.12%)。下呼吸道感染病原体居前5位的分别是鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌,分别占25.49%、15.26%、14.63%、13.37%和5.09%。结论 ICU目标性监测有助于了解医院获得性下呼吸道感染情况,各医院应针对本单位的监测结果 ,积极查找原因,并加强ICU医院感染控制标准规范的学习,开展目标性监测,提高ICU医务人员对VAP感染预防措施的认知程度与措施执行力。

Multicenter monitoring report on intensive care unit acquired lower respiratory tract infection

ObjectiveTo understand the status of intensive care unit acquired lower respiratory tract infection (ICU LRTI), and the distribution characteristics of pathogens, so as to provide the basis for taking preventive and control measures, and scientific diagnosis and treatment for patients.  MethodsTargeted monitoring data on healthcare associated infection (HAI) in ICUs of 32 hospitals in a province in 2013 were investigated retrospectively. ResultsThe incidence of ICU LRTI was 5.79%, ventilator usage rate  was 31.25%, incidence of ventilator associated pneumonia(VAP) was 26.93‰;There was no linear correlation between ventilator usage rate and incidence of VAP（r=0.160，P=0.380）. A total of 1 593 pathogens causing LRTI were detected, the major were gram negative bacteria （75.77 %,n=1 207）, followed by gram positive bacteria（18.21%,n=290），fungi（5.90%,n=94），Mycoplasma pneumonia and other pathogens（0.12 %, n=1 for each）.The top five detected pathogens causing LRTI were Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli, accounting for 25.49%, 15.26%, 14.63%, 13.37% and 5.09% respectively.ConclusionTargeted monitoring on ICU is helpful for realizing healthcare associated  LRTI, each hospital should conduct targeted monitor to find out the causes of HAI, as well as improve the awareness of VAP among ICU health care workers.