International Nosocomial Infection Control Consortium, Buenos Aires, Argentina.
Am J Infect Control. 2010 Mar;38(2):95-104.e2. doi: 10.1016/j.ajic.2009.12.004.
We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).
我们报告了国际感染控制联合会（INICC）2003 年 1 月至 2008 年 12 月间在拉丁美洲、亚洲、非洲和欧洲 173 个重症监护病房（ICU）的监测研究结果。在这项为期 6 年的研究中，我们使用美国疾病控制与预防中心（CDC）国家卫生保健安全网络（NHSN；前身为国家医院感染监测系统[NNIS]）对器械相关和医疗保健相关感染的定义，从 ICU 住院患者中前瞻性收集了 155358 例患者的资料，总计 923624 天。尽管发展中国家 ICU 的器械使用率与 CDC NHSN 报道的美国 ICU 非常相似，但 INICC 医院 ICU 中器械相关医院感染的发生率明显更高：INICC ICU 中心静脉导管（CVC）相关血流感染（BSI）的合并发生率为每 1000 个 CVC 日 7.6 例，几乎是可比美国 ICU 报道的每 1000 个 CVC 日 2.0 例的 3 倍，呼吸机相关性肺炎（VAP）的总发生率也高得多，分别为每 1000 个呼吸机日 13.6 例和 3.3 例，导管相关尿路感染（CAUTI）的发生率也分别为每 1000 个导管日 6.3 例和 3.3 例。最引人注目的是，金黄色葡萄球菌分离株对甲氧西林的耐药率（MRSA）（分别为 84.1%和 56.8%）、肺炎克雷伯菌对头孢他啶或头孢曲松的耐药率（分别为 76.1%和 27.1%）、鲍曼不动杆菌对亚胺培南的耐药率（分别为 46.3%和 29.2%）和铜绿假单胞菌对哌拉西林的耐药率（分别为 78.0%和 20.2%）也远高于该联合会的 ICU，器械相关感染的未调整粗死亡率范围从 23.6%（CVC 相关血流感染）到 29.3%（VAP）。
