Evans Charlesnika T, LaVela Sherri L, Weaver Frances M, Priebe Michael, Sandford Paul, Niemiec Pamela, Miskevics Scott, Parada Jorge P
Department of Veterans Affairs, Center for Management of Complex Chronic Care, and the Infection Control Section, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
Infect Control Hosp Epidemiol. 2008 Mar;29(3):234-42. doi: 10.1086/527509.
To describe the epidemiology of hospital-acquired infections (HAIs) in veterans with spinal cord injury and disorder (SCI&D).
Retrospective medical record review.
Midwestern Department of Veterans Affairs spinal cord injury center.
A total of 226 patients with SCI&D hospitalized at least once during a 2-year period (October 1, 2001, through September 30, 2003).
A total of 549 hospitalizations were included in the analysis (mean duration of hospitalization, 33.7 days); an HAI occurred during 182 (33.2%) of these hospitalizations. A total of 657 HAIs occurred during 18,517 patient-days in the hospital (incidence rate, 35.5 HAIs per 1,000 patient-days). Almost half of the 226 patients had at least 1 HAI; the mean number of HAIs among these patients was 6.0 HAIs per patient. The most common HAIs were urinary tract infection (164 [25.0%] of the 657 HAIs; incidence rate, 8.9 cases per 1,000 patient-days), bloodstream infection (111 [16.9%]; incidence rate, 6.0 cases per 1,000 patient-days), and bone and joint infection (103 [15.7%]; incidence rate, 5.6 cases per 1,000 patient-days). The most common culture isolates were gram-positive bacteria (1,082 [45.6%] of 2,307 isolates), including Staphylococcus aureus, and gram-negative bacteria (1,033 [43.6%] of isolates), including Pseudomonas aeruginosa. Multivariable regression demonstrated that predictors of HAI were longer length of hospital stay (P=.002), community-acquired infection (P=.007), and use of a urinary invasive device (P=.01) or respiratory invasive device (P=.04).
The overall incidence of HAIs in persons with SCI&D was higher than that reported for other populations, confirming the increased risk of HAI in persons with spinal cord injury. The increased risk associated with longer length of stay and with community-acquired infection suggests that strategies are needed to reduce the duration of hospitalization and to effectively treat community-acquired infection, to decrease infection rates. There is significant room for improvement in reducing the incidence of HAIs in this population.
描述脊髓损伤与疾病（SCI&D）退伍军人医院获得性感染（HAIs）的流行病学特征。
回顾性病历审查。
中西部退伍军人事务部脊髓损伤中心。
在2年期间（2001年10月1日至2003年9月30日）至少住院1次的226例SCI&D患者。
分析共纳入549次住院（平均住院时间33.7天）；其中182次住院（33.2%）发生了HAI。在医院的18517个患者日中共发生657例HAI（发病率为每1000个患者日35.5例HAI）。226例患者中近一半至少发生1次HAI；这些患者中HAI的平均数量为每人6.0次。最常见的HAI是尿路感染（657例HAI中的164例[25.0%]；发病率为每1000个患者日8.9例）、血流感染（111例[16.9%]；发病率为每1000个患者日6.0例）和骨与关节感染（103例[15.7%]；发病率为每1000个患者日5.6例）。最常见的培养分离菌是革兰氏阳性菌（2307株分离菌中的1082株[45.6%]），包括金黄色葡萄球菌，以及革兰氏阴性菌（分离菌中的1033株[43.6%]），包括铜绿假单胞菌。多变量回归表明，HAI的预测因素是住院时间延长（P = 0.002）、社区获得性感染（P = 0.007）以及使用侵入性泌尿设备（P = 0.01）或侵入性呼吸设备（P = 0.04）。
SCI&D患者中HAI的总体发病率高于其他人群报告的发病率，证实脊髓损伤患者发生HAI的风险增加。与住院时间延长和社区获得性感染相关的风险增加表明，需要采取策略来缩短住院时间并有效治疗社区获得性感染，以降低感染率。在降低该人群中HAI的发病率方面有很大的改进空间。
