Moreno Carlos Alvarez, Rosenthal Victor D, Olarte Narda, Gomez Wilmer Villamil, Sussmann Otto, Agudelo Julio Garzon, Rojas Catherine, Osorio Laline, Linares Claudia, Valderrama Alberto, Mercado Patricia Garrido, Bernate Patrick Hernan Arrieta, Vergara Guillermo Ruiz, Pertuz Alberto Marrugo, Mojica Beatriz Eugenia, Navarrete Maria del Pilar Torres, Romero Ana Sofia Alonso, Henriquez Daibeth
Simon Bolivar Hospital, Bogata, Columbia.
Infect Control Hosp Epidemiol. 2006 Apr;27(4):349-56. doi: 10.1086/503341. Epub 2006 Mar 29.
To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.
We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.
During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)-related bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P=.002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P=.19).
The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia.
在哥伦比亚9家医院的10个重症监护病房（ICU）开展主动目标性前瞻性监测，以测定器械相关感染（DAI）率、DAI所致的可归因死亡率，以及感染病原体的微生物学和抗生素耐药谱，这些医院均为国际感染控制联盟的成员。
我们采用美国疾病控制与预防中心国家医院感染监测系统（NNIS）的定义，对9家医院的医疗保健相关感染进行前瞻性监测。DAI率的计算方法为每100例ICU患者和每1000个器械日的感染例数。
在为期3年的研究中，2172例入住ICU的患者累计住院时长为14603天，发生了266例DAI，总体DAI率为12.2%，即每1000患者日有18.2例DAI。中心静脉导管（CVC）相关血流感染（BSI）（占DAI的47.4%；每1000导管日11.3例）是最常见的DAI，其次是呼吸机相关性肺炎（VAP）（占DAI的32.3%；每1000呼吸机日10.0例）和导管相关性尿路感染（CAUTI）（占DAI的20.3%；每1000导管日4.3例）。总体而言，所有金黄色葡萄球菌感染中65.4%由耐甲氧西林菌株引起；40.0%的肠杆菌科分离株对头孢曲松耐药，28.3%对头孢他啶耐药；40.0%的铜绿假单胞菌分离株对氟喹诺酮类耐药，50.0%对头孢他啶耐药，33.3%对哌拉西林-他唑巴坦耐药，19.0%对亚胺培南耐药。VAP患者的粗未调整可归因死亡率为16.9%（相对危险度[RR]，1.93；95%置信区间[CI]，1.24 - 3.00；P = 0.002）；CVC相关BSI患者为18.5%（RR，2.02；95% CI，1.42 - 2.87；P < 0.001）；CAUTI患者为10.5%（RR，1.58；95% CI，0.78 - 3.18；P = 0.19）。
哥伦比亚ICU的DAI率低于其他一些拉丁美洲国家报告中的水平，高于NNIS报告的美国ICU的水平。这些数据表明哥伦比亚需要更有效的感染控制干预措施。
