Groot A J, Geubbels E L, Beaumont M T, Wille J C, de Boer A S
Kwaliteitsinstituut voor de Gezondheidszorg CBO, Postbus 20.064, 3502 LB Utrecht. mw.dr.A.J.Mintjes-de Groot
Ned Tijdschr Geneeskd. 2001 Jun 30;145(26):1249-54.
To gain insight into the incidence of nosocomial infections and associated risk factors in Intensive Care Units (ICUs).
Prospective.
From July 1997 to December 1999, standardised surveillance of nosocomial infections was implemented in ICUs in 16 hospitals in the Netherlands. Surveillance was performed in patients with an ICU stay of > or = 48 hrs; data were collected from admission until discharge from ICU. Data-collection included demographic data and patient- and treatment-related risk factors. The data were aggregated in a national database.
In the research period, hospitals sent good quality data for aggregation in the national database on 2795 patients (61% male) and 27,922 ICU patient days. The median length of stay was six days, the median 'Acute physiology and chronic health evaluation' (APACHE) II score was 17 and the median age was 67 years. A total number of 749 infected patients were found with 1,177 nosocomial infections (27% of patients, 42 infections/1000 patient days), consisting of 43% pneumonia, 20% sepsis, 21% urinary tract infections, 16% other types of infections. Out of all the patients, 62% was on mechanical ventilation, 64% had a central venous line and 89% had a urinary catheter in situ. Selective decontamination of the gastrointestinal tract was used for 12% of the patients, and systemic antibiotics for 68%. Micro-organisms most frequently isolated were Pseudomonas aeruginosa in patients with pneumonia, Staphylococcus epidermidis in catheter-related bloodstream infections and Escherichia coli in patients with urinary tract infections. Large differences in device use and incidence of infections were observed between the ICUs.
The aggregated data gave insight into the incidence of nosocomial infections and associated risk factors in ICUs. The data are meant as references to support decision- and policy-making in local infection control programs.
深入了解重症监护病房（ICU）医院感染的发生率及相关危险因素。
前瞻性研究。
1997年7月至1999年12月，在荷兰16家医院的ICU中实施医院感染的标准化监测。对入住ICU≥48小时的患者进行监测；收集从入院至出院的数据。数据收集包括人口统计学数据以及与患者和治疗相关的危险因素。数据汇总至国家数据库。
在研究期间，各医院将关于2795例患者（61%为男性）和27922个ICU患者日的高质量数据发送至国家数据库进行汇总。中位住院时间为6天，中位急性生理与慢性健康状况评分（APACHE）II为17分，中位年龄为67岁。共发现749例感染患者，发生1177例医院感染（占患者的27%，42例感染/1000患者日），其中43%为肺炎，20%为脓毒症，21%为尿路感染，16%为其他类型感染。所有患者中，62%接受机械通气，64%有中心静脉置管，89%有留置导尿管。12%的患者使用了胃肠道选择性去污，68%的患者使用了全身抗生素。最常分离出的微生物为肺炎患者中的铜绿假单胞菌、导管相关血流感染患者中的表皮葡萄球菌以及尿路感染患者中的大肠埃希菌。各ICU之间在器械使用和感染发生率方面存在较大差异。
汇总数据有助于深入了解ICU医院感染的发生率及相关危险因素。这些数据可作为参考，以支持地方感染控制项目中的决策和政策制定。
