Cağatay A Atahan, Ozcan Perihan Ergin, Gulec Leyla, Ince Nurhan, Tugrul Simru, Ozsut Halit, Cakar Nahit, Esen Figen, Eraksoy Haluk, Calangu Semra
Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine,Istanbul University, Istanbul, Turkey.
Med Princ Pract. 2007;16(3):187-92. doi: 10.1159/000100388.
The aim of this study was to follow critically ill patients prospectively in intensive care units (ICUs) to determine risk factors for mortality and outcome associated with nosocomial bacteraemia (NB).
A case-control study of 176 patients was conducted to identify the risk factors for mortality of NB in ICU patients. The study was performed in emergency, surgical and general surgical ICUs with 23 beds during a 15-month period. A total of 1,450 patients were admitted to the ICUs during the study period. The USA Center for Disease Control and Prevention definitions were used to diagnose nosocomial infections. Nosocomial bacteraemia was defined as the isolation of one or more organisms from blood cultures taken at least 48 h after admission, which were not related to a problem present on admission. An assessment of whether the isolated organisms represented true bacteraemia rather than contamination was made by clinical or laboratory evidence of infection.
A total of 214 bacteraemia episodes were found in the 176 patients (64 female, 112 male; 51.3 +/- 21.3 years old), 90 of whom died and 86 survived. The bacteraemia rate was 12.1%. The most common etiological agents of bacteraemia were Klebsiella pneumoniae: 46 (21.5%), methicillin-resistant Staphylococcus aureus: 46 (21.5%), Pseudomonas aeruginosa: 32 (14.9%), and Escherichia coli: 20 (9.3%). Multivariate analysis showed that the requirement of mechanical ventilation for more than 7 days (p < 0.001), total parenteral nutrition (p = 0.034), inotropic drug (p < 0.001), and increased creatinine level (p = 0.034) were independent risk factors for mortality of NB in ICUs.
Nosocomial infections caused by Gram-negative bacteria continue to be one of the major sources of morbidity and mortality.
本研究旨在对重症监护病房（ICU）中的重症患者进行前瞻性跟踪，以确定与医院获得性菌血症（NB）相关的死亡风险因素和结局。
对176例患者进行病例对照研究，以确定ICU患者NB死亡的风险因素。该研究在拥有23张床位的急诊、外科和普通外科ICU中进行，为期15个月。研究期间共有1450例患者入住ICU。采用美国疾病控制与预防中心的定义来诊断医院感染。医院获得性菌血症定义为入院至少48小时后血培养分离出一种或多种病原体，且与入院时存在的问题无关。通过感染的临床或实验室证据评估分离出的病原体是否代表真正的菌血症而非污染。
176例患者（64例女性，112例男性；年龄51.3±21.3岁）共发生214次菌血症发作，其中90例死亡，86例存活。菌血症发生率为12.1%。菌血症最常见的病原体为肺炎克雷伯菌：46例（21.5%），耐甲氧西林金黄色葡萄球菌：46例（21.5%），铜绿假单胞菌：32例（14.9%），大肠埃希菌：20例（9.3%）。多因素分析显示，机械通气超过7天（p<0.001）、全胃肠外营养（p = 0.034）、血管活性药物（p<0.001）以及肌酐水平升高（p = 0.034）是ICU中NB死亡的独立风险因素。
革兰阴性菌引起的医院感染仍然是发病和死亡的主要来源之一。
