Orsi G B, Scorzolini L, Franchi C, Mondillo V, Rosa G, Venditti M
Department of Public Health Sciences, University La Sapienza, Rome, Italy.
J Hosp Infect. 2006 Sep;64(1):23-9. doi: 10.1016/j.jhin.2006.02.022. Epub 2006 Jul 11.
A prospective study on hospital-acquired infection (HAI) was undertaken in the eight-bed neurosurgical intensive care unit (NSICU) of a teaching hospital in Rome, Italy. All patients admitted for >48 h between January 2002 and December 2004 were included. The infection control team collected the following data from all patients: demographic characteristics, patient origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated micro-organisms and antibiotic susceptibilities. Overall, 323 patients were included in the study. Mean age was 55.5 years (range 17-91), and mean American Society of Anesthesiologists' score was 2.88. Seventy (21.7%) patients developed 132 NSICU HAIs: 43 pneumonias, 40 bloodstream infections (BSIs), 30 urinary tract infections (UTIs), 10 cases of meningitis associated with an external ventricular drain (EVD) and nine surgical site infections (SSIs). The SSI rate was high (5.6%), but a reduction was achieved during the three-year period. There were 7.2 bloodstream infection episodes per 1000 days of device exposure; 11.00 pneumonias per 1000 days of mechanical ventilation and 4.5 UTIs per 1,000 days of urinary catheterisation. Among patients with an EVD, the SSI relative risk was 11.3 [95% confidence intervals (CI) 4.2-30.6; P<0.01]. Sixty-one (18.9%) patients died. Logistic regression analysis showed that mortality was significantly associated with infection [odds ratio (OR)=2.28; 95%CI 1.11-4.71; P=0.02] and age (OR=1.04; 95%CI 1.01-1.06; P=0.002). Candida spp. were the leading cause of UTIs (40.0%) and the third most common cause of BSIs (12.7%). Antibiotic-resistant pathogens included meticillin-resistant staphylococci (77.5%), carbapenem-resistant Pseudomonas aeruginosa (36.4%), and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (75.0%). Although the overall incidence of infection (21.7%) was within the range of published data, the associated mortality, the increasing severity of illness of patients, and the emergence of multi-drug-resistant organisms shows the need to improve infection control measures.
在意大利罗马一家教学医院的八张床位的神经外科重症监护病房（NSICU）进行了一项关于医院获得性感染（HAI）的前瞻性研究。纳入了2002年1月至2004年12月期间住院时间超过48小时的所有患者。感染控制团队收集了所有患者的以下数据：人口统计学特征、患者来源、诊断、严重程度评分、基础疾病、侵入性操作、医院获得性感染、分离出的微生物及抗生素敏感性。总体而言，323例患者纳入了该研究。平均年龄为55.5岁（范围17 - 91岁），美国麻醉医师协会平均评分为2.88。70例（21.7%）患者发生了132例NSICU医院获得性感染：43例肺炎、40例血流感染（BSI）、30例尿路感染（UTI）、10例与外置脑室引流管（EVD）相关的脑膜炎及9例手术部位感染（SSI）。手术部位感染率较高（5.6%），但在三年期间有所下降。每1000天设备暴露发生7.2例血流感染事件；每1000天机械通气发生11.00例肺炎，每1000天导尿发生4.5例尿路感染。在有EVD的患者中，手术部位感染的相对风险为11.3[95%置信区间（CI）4.2 - 30.6；P<0.01]。61例（18.9%）患者死亡。逻辑回归分析显示，死亡率与感染显著相关[比值比（OR）=2.28；95%CI 1.11 - 4.71；P = 0.02]及年龄（OR = 1.04；95%CI 1.01 - 1.06；P = 0.002）。念珠菌属是尿路感染的主要原因（40.0%），也是血流感染的第三大常见原因（12.7%）。耐抗生素病原体包括耐甲氧西林葡萄球菌（77.5%）、耐碳青霉烯铜绿假单胞菌（36.4%）及产超广谱β-内酰胺酶肺炎克雷伯菌（75.0%）。尽管总体感染发生率（21.7%）在已发表数据范围内，但相关死亡率、患者病情严重程度增加及多重耐药菌的出现表明需要改进感染控制措施。
