某教学医院新建综合ICU连续三年医院感染目标性监测及其危险因素
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安徽省第二人民医院医院感染管理科, 安徽 合肥 230041

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王云  E-mail: 94373564@qq.com

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Targeted surveillance and risk factors for healthcare-associated infection in the newly-built general intensive care unit of a teaching hospital for three consecutive years
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Department of Healthcare-associated Infection Management, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China

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    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1 133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(χ2=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。

    Abstract:

    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 1 133 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 1 000 bed-day, case incidence was 17.32‰ per 1 000 bed-day, incidence of HAI adjusted by patient's average severity was 3.65‰ per 1 000 bed-day, case incidence was 5.30‰ per 1 000 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%, χ2=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 Staphylococcus aureus to oxacillin was 81.25%. Conclusion Incidence of device-associated infection in newly-built general ICU is high, especially CLABSI, antimicrobial resistance of the main pathogens is serious, corresponding prevention and control measures according to the characteristics of related infection should be formulated to reduce the occurrence of HAI.

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王云,管子姝,盛波,等.某教学医院新建综合ICU连续三年医院感染目标性监测及其危险因素[J]. 中国感染控制杂志,2021,(8):735-741. DOI:10.12138/j. issn.1671-9638.20217575.
Yun WANG, Zi-shu GUAN, Bo SHENG, et al. Targeted surveillance and risk factors for healthcare-associated infection in the newly-built general intensive care unit of a teaching hospital for three consecutive years[J]. Chin J Infect Control, 2021,(8):735-741. DOI:10.12138/j. issn.1671-9638.20217575.

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  • 收稿日期:2020-12-08
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  • 在线发布日期: 2021-09-06
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