一家泰国大学医院儿科重症监护病房的多重耐药医院相关感染：一项横断面调查
Multidrug-resistant hospital-associated infections in a pediatric intensive care unit: a cross-sectional survey in a Thai university hospital.
作者信息
Sritippayawan Suchada, Sri-Singh Klaita, Prapphal Nuanchan, Samransamruajkit Rujipat, Deerojanawong Jitladda
机构信息
Division of Pulmonology and Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Rd, Bangkok 10330, Thailand.
出版信息
Int J Infect Dis. 2009 Jul;13(4):506-12. doi: 10.1016/j.ijid.2008.08.022. Epub 2008 Dec 9.
OBJECTIVE
To determine the incidence and associated factors of multidrug-resistant hospital-associated infections (MDR-HAI) in a pediatric intensive care unit (PICU) of a university hospital in Thailand.
METHOD
A prospective study was performed in the PICU of King Chulalongkorn Memorial Hospital during the period May-December 2005. Children aged < or = 15 years who developed a PICU-related HAI were studied.
RESULTS
Forty-four patients (median age 6 months; male:female = 1.4:1) developed 58 episodes of PICU-related HAI. The HAI rate was 28.3 per 1000 patient-days. Thirty episodes (52%) were MDR-HAI. The following were found more frequently in MDR-HAI when compared to non-MDR-HAI: Acinetobacter baumannii (50% vs. 23%, p = 0.04), female sex (60% vs. 29%, p = 0.02), admission to the PICU with a medical condition (90% vs. 64%, p = 0.03), PICU stay longer than 7 days prior to the development of HAI (67% vs. 36%, p = 0.03), and previous use of broad-spectrum antibiotics (83% vs. 43%, p = 0.002). Independent risk factors for MDR-HAI included female sex (OR = 5.5, p = 0.03) and previous use of a broad-spectrum antibiotic (OR = 9.7, p = 0.01).
CONCLUSION
The incidence of MDR-HAI was high in the PICU. Female sex and previous use of a broad-spectrum antibiotic were independent risk factors for MDR-HAI.
目的
确定泰国一家大学医院儿科重症监护病房（PICU）中多重耐药医院获得性感染（MDR-HAI）的发生率及相关因素。
方法
于2005年5月至12月期间在朱拉隆功国王纪念医院的PICU进行了一项前瞻性研究。对年龄≤15岁且发生PICU相关医院获得性感染的儿童进行研究。
结果
44例患者（中位年龄6个月；男女比例为1.4:1）发生了58次PICU相关医院获得性感染。医院获得性感染率为每1000患者日28.3次。30次感染（52%）为多重耐药医院获得性感染。与非多重耐药医院获得性感染相比，多重耐药医院获得性感染中以下情况更为常见：鲍曼不动杆菌（50%对23%，p = 0.04）、女性（60%对29%，p = 0.02）、因内科疾病入住PICU（90%对64%，p = 0.03）、在发生医院获得性感染前PICU住院时间超过7天（67%对36%，p = 0.03）以及既往使用过广谱抗生素（83%对43%，p = 0.002）。多重耐药医院获得性感染的独立危险因素包括女性（比值比=5.5，p = 0.03）和既往使用过广谱抗生素（比值比=9.7，p = 0.01）。
结论
PICU中多重耐药医院获得性感染的发生率较高。女性和既往使用广谱抗生素是多重耐药医院获得性感染的独立危险因素。
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