摘要
目的了解新建综合ICU医院感染目标性监测情况及其危险因素,为制定相关医院感染防控措施提供依据。方法对2017—2019年入住某医院新建综合ICU患者进行医院感染目标性监测,分析医院感染危险因素及医院感染病原菌情况。结果共监测1133例患者,发生医院感染120例(174例次),医院感染率10.59%,例次感染率15.36%;医院感染日发病率为11.95‰,例次日发病率17.32‰,根据患者平均病情严重程度调整医院感染日发病率为3.65‰,调整例次日发病率为5.30‰。呼吸机、导尿管和中心静脉插管使用率分别为44.25%、85.19%、52.19%,呼吸机相关肺炎、导尿管相关尿路感染和中心静脉导管相关血流感染发病率分别为12.37‰、0.35‰、6.10‰。医院感染部位以下呼吸道为主(64.94%),其次为血液(21.27%)和泌尿道(3.45%)。ICU住院日数≥14 d(OR=0.122,95%CI:0.036~0.414,P=0.001)、输血(OR=0.233,95%CI:0.104~0.522,P<0.001)、APECHE II评分≥20分(OR=0.358,95%CI:0.175~0.733,P=0.005)和气管切开(OR=0.158,95%CI:0.066~0.374,P<0.001)是ICU患者医院感染的独立危险因素。ICU医院感染患者病死率(37.50%)高于非医院感染患者(28.04%),差异有统计学意义(χ^(2)=4.664,P=0.031)。120例医院感染患者共检出147株病原菌,以革兰阴性菌(58.50%)为主,居前5位的是肺炎克雷伯菌(19.05%)、白念珠菌(17.69%)、铜绿假单胞菌(15.65%)、金黄色葡萄球菌(10.89%)和鲍曼不动杆菌(占6.80%)。肺炎克雷伯菌、铜绿假单胞菌对亚胺培南耐药率分别为14.29%、65.22%,金黄色葡萄球菌对苯唑西林的耐药率为81.25%。结论新建综合ICU器械相关感染发病率较高,尤其是中心静脉导管相关血流感染,检出主要病原菌耐药严重,应根据相关感染特点制定相应防控措施,减少医院感染的发生。
Objective To understand the targeted surveillance and risk factors for healthcare-associated infection(HAI)in a newly-built general intensive care unit(ICU),and provide basis for formulating relevant prevention and control measures of HAI.Methods Targeted surveillance on HAI in patients who were admitted to a newly-built general ICU in 2017-2019 was performed,risk factors and pathogens of HAI were analyzed.Results A total of 1133 patients were monitored,120 cases(174 times)of HAI occurred,HAI rate was 10.59%,case infection rate was 15.36%;incidence of HAI was 11.95‰ per 1000 bed-day,case incidence was 17.32‰ per 1000 bed-day,incidence of HAI adjusted by patient’s average severity was 3.65‰ per 1000 bed-day,case incidence was 5.30‰per 1000 bed-day.Utilization rates of respirator,urinary catheter and central venous catheter were 44.25%,85.19% and 52.19% respectively,incidence of ventilator-associated pneumonia,catheter-associated urinary tract infection and central line-associated bloodstream infection(CLABSI)were 12.37‰,0.35‰,and 6.10‰ respectively.The main HAI site was lower respiratory tract(64.94%),followed by blood(21.27%)and urinary tract(3.45%).Length of ICU stay≥14 days(OR=0.122,95%CI:0.036-0.414,P=0.001),blood transfusion(OR=0.233,95%CI:0.104-0.522,P<0.001),APACHE II score≥20 points(OR=0.358,95%CI:0.175-0.733,P=0.005)and tracheotomy(OR=0.158,95%CI:0.066-0.374,P<0.001)were independent risk factors for HAI in ICU patients.The mortality of ICU patients with HAI was higher than that of patients without HAI(37.50%vs 28.04%,χ^(2)=4.664,P=0.031).A total of 147 strains of pathogenic bacteria were isolated from 120 patients with HAI,predominantly Gram-negative bacteria(58.50%),the top 5 pathogens of HAI were Klebsiella pneumoniae(19.05%),Candida albicans(17.69%),Pseudomonas aeruginosa(15.65%),Staphylococcus aureus(10.89%)and Acinetobacter baumannii(6.80%).Resistance rates of Klebsiella pneumoniae and Pseudomonas aeruginosa to imipenem were 14.29% and 65.22% respectively,resistance rate of Staph
作者
王云
管子姝
盛波
闫萍
WANG Yun;GUAN Zi-shu;SHENG Bo;YAN Ping(Department of Healthcare-associated Infection Management,Anhui No.2 Provincial People’s Hospital,Hefei 230041,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2021年第8期735-741,共7页
Chinese Journal of Infection Control
关键词
医院感染
重症监护病房
器械相关感染
器械使用率
目标性监测
危险因素
healthcare-associated infection
intensive care unit
device-associated infection
device utilization rate
targeted surveillance
risk factor
