Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany.
J Hosp Infect. 2010 Oct;76(2):108-13. doi: 10.1016/j.jhin.2010.04.010.
Two multivariate time-series analyses were carried out to identify the impact of bed occupancy rates, turnover intervals and the average length of hospital stay on the spread of multidrug-resistant bacteria in a teaching hospital. Epidemiological data on the incidences of meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing bacteria were collected. Time-series of bed occupancy rates, turnover intervals and the average length of stay were tested for inclusion in the models as independent variables. Incidence was defined as nosocomial cases per 1000 patient-days. This included all patients infected or colonised with MRSA/ESBL more than 48h after admission. Between January 2003 and July 2008, a mean incidence of 0.15 nosocomial MRSA cases was identified. ESBL was not included in the surveillance until January 2005. Between January 2005 and July 2008 the mean incidence of nosocomial ESBL was also 0.15 cases per 1000 patient-days. The two multivariate models demonstrate a temporal relationship between bed occupancy rates in general wards and the incidence of nosocomial MRSA and ESBL. Similarly, the temporal relationship between the monthly average length of stay in intensive care units (ICUs) and the incidence of nosocomial MRSA and ESBL was demonstrated. Overcrowding in general wards and long periods of ICU stay were identified as factors influencing the spread of multidrug-resistant bacteria in hospital settings.
进行了两项多变量时间序列分析，以确定病床占用率、周转率和平均住院时间对教学医院多药耐药菌传播的影响。收集了耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β-内酰胺酶（ESBL）细菌发病率的流行病学数据。对病床占用率、周转率和平均住院时间时间序列进行了测试，以确定它们是否作为独立变量纳入模型。发病率定义为每 1000 个患者日发生的医院感染病例数。这包括入院后 48 小时以上感染或定植 MRSA/ESBL 的所有患者。在 2003 年 1 月至 2008 年 7 月期间，确定了 0.15 例医院获得性 MRSA 感染的平均发病率。直到 2005 年 1 月才开始对 ESBL 进行监测。在 2005 年 1 月至 2008 年 7 月期间，医院获得性 ESBL 的平均发病率也为每 1000 个患者日 0.15 例。这两个多变量模型表明普通病房的病床占用率与医院获得性 MRSA 和 ESBL 的发病率之间存在时间关系。同样，重症监护病房（ICU）每月平均住院时间与医院获得性 MRSA 和 ESBL 发病率之间的时间关系也得到了证明。普通病房拥挤和 ICU 住院时间长被确定为影响医院环境中多药耐药菌传播的因素。
