Gaynes Robert, Edwards Jonathan R
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 2005 Sep 15;41(6):848-54. doi: 10.1086/432803. Epub 2005 Aug 16.
We analyzed data from the National Nosocomial Infections Surveillance (NNIS) System from 1986-2003 to determine the epidemiology of gram-negative bacilli in intensive care units (ICUs) for the most frequent types of hospital-acquired infection: pneumonia, surgical site infection (SSI), urinary tract infection (UTI), and bloodstream infection (BSI). We analyzed >410,000 bacterial isolates associated with hospital-acquired infections in ICUs during 1986-2003. In 2003, gram-negative bacilli were associated with 23.8% of BSIs, 65.2% of pneumonia episodes, 33.8% of SSIs, and 71.1% of UTIs. The percentage of BSIs associated with gram-negative bacilli decreased from 33.2% in 1986 to 23.8% in 2003. The percentage of SSIs associated with gram-negative bacilli decreased from 56.5% in 1986 to 33.8% in 2003. The percentages pneumonia episodes and UTIs associated with gram-negative bacilli remained constant during the study period. The proportion of ICU pneumonia episodes associated with Acinetobacter species increased from 4% in 1986 to 7.0% in 2003 (P<.001, by the Cochran-Armitage chi2 test for trend). Significant increases in resistance rates were uniformly seen for selected antimicrobial-pathogen combinations. Gram-negative bacilli are commonly associated with hospital-acquired infections in ICUs. The proportion of Acinetobacter species associated with ICU pneumonia increased from 4% in 1986 to 7.0% in 2003.
我们分析了1986年至2003年国家医院感染监测（NNIS）系统的数据，以确定重症监护病房（ICU）中革兰氏阴性杆菌在最常见的医院获得性感染类型（肺炎、手术部位感染（SSI）、尿路感染（UTI）和血流感染（BSI））方面的流行病学情况。我们分析了1986年至2003年期间ICU中与医院获得性感染相关的超过410,000株细菌分离株。2003年，革兰氏阴性杆菌与23.8%的血流感染、65.2%的肺炎发作、33.8%的手术部位感染以及71.1%的尿路感染相关。与革兰氏阴性杆菌相关的血流感染百分比从1986年的33.2%降至2003年的23.8%。与革兰氏阴性杆菌相关的手术部位感染百分比从1986年的56.5%降至2003年的33.8%。在研究期间，与革兰氏阴性杆菌相关的肺炎发作和尿路感染百分比保持不变。与不动杆菌属相关的ICU肺炎发作比例从1986年的4%增至2003年的7.0%（经趋势Cochran-Armitage卡方检验，P<0.001）。对于选定的抗菌药物 - 病原体组合，耐药率均显著增加。革兰氏阴性杆菌通常与ICU中的医院获得性感染相关。与ICU肺炎相关的不动杆菌属比例从1986年的4%增至2003年的7.0%。
