Aly Nasser Yehia A, Al-Mousa Haifaa H, Al Asar El Sayed M
Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Med Princ Pract. 2008;17(5):373-7. doi: 10.1159/000141500. Epub 2008 Aug 6.
We aimed to describe the pattern of nosocomial infections in an adult medical-surgical intensive care unit (ICU).
A 2-year prospective cohort study of nosocomial infection surveillance in a 15-bed adult combined medical and surgical ICU of Farwaniya Hospital, Kuwait, was carried out. Data were collected between January 2004 and December 2005 using the standard surveillance protocols and nosocomial infection site definitions of the National Nosocomial Infections Surveillance System's ICU surveillance component.
Of 1,173 patients hospitalized in the ICU for an aggregate duration of 6,855 days, 89 patients acquired a total of 140 nosocomial infections; 46 (33%) ventilator-associated pneumonia (VAP), 33 (24%) central-line-associated bloodstream infection and 15 (11%) catheter-associated urinary tract infection, 22 (16%) cutaneous infection and 24 (17%) other infections. The overall patient day rate was 20.6/1,000 patient days. The patient infection rate was 10.6/100 patients at risk. The mean VAP rate was 9.1/1,000 ventilator days (95% CI, 5-13.2), the central-line-associated bloodstream infection rate 5.5/1,000 central line days (95% CI, 3.2-7.8) and the catheter-associated urinary tract infection rate 2.3/1,000 catheter days (95% CI, 1.2-3.4). Of all nosocomial infections, 119 (85%) were culture-confirmed and 21 (15%) were clinically defined culture-negative infections. Of the culture-confirmed nosocomial infections, 81 (68%) were Gram-negative, 32 (27%) Gram-positive and 6 (5%) fungal. The most frequent organism was Pseudomonas aeruginosa (20, 17%), followed by Acinetobacter baumannii (15, 13%), Klebsiella spp. (13, 11%) and Escherichia coli (10, 8%). The crude mortality was 27% among ICU-infected patients.
VAP was the most common nosocomial infection in our ICU. Gram-negative organisms were more commonly reported as etiologic agents of ICU infections.
我们旨在描述一所成人内科-外科重症监护病房（ICU）中医院感染的模式。
在科威特法瓦尼亚医院拥有15张床位的成人内科与外科联合ICU开展了一项为期2年的医院感染监测前瞻性队列研究。2004年1月至2005年12月期间，使用国家医院感染监测系统ICU监测部分的标准监测方案和医院感染部位定义收集数据。
在ICU住院的1173例患者，累计住院时长6855天，其中89例患者共发生140例医院感染；46例（33%）为呼吸机相关性肺炎（VAP），33例（24%）为中心静脉导管相关血流感染，15例（11%）为导尿管相关尿路感染，22例（16%）为皮肤感染，24例（17%）为其他感染。总体患者日感染率为20.6/1000患者日。患者感染率为10.6/100例有感染风险的患者。VAP的平均发生率为9.1/1000呼吸机日（95%可信区间，5 - 13.2），中心静脉导管相关血流感染率为5.5/1000中心静脉导管日（95%可信区间，3.2 - 7.8），导尿管相关尿路感染率为2.3/1000导尿管日（95%可信区间，1.2 - 3.4）。在所有医院感染中，119例（85%）经培养确诊，21例（15%）为临床定义的培养阴性感染。在培养确诊的医院感染中，81例（68%）为革兰阴性菌感染，32例（27%）为革兰阳性菌感染，6例（5%）为真菌感染。最常见的病原体是铜绿假单胞菌（20例，17%），其次是鲍曼不动杆菌（15例，13%）、克雷伯菌属（13例，11%）和大肠埃希菌（10例，8%）。ICU感染患者的粗死亡率为27%。
VAP是我们ICU中最常见的医院感染。革兰阴性菌更常被报告为ICU感染的病原体。
