魁北克省重症监护病房中心静脉相关血流感染的流行病学：6 年回顾。
Epidemiology of central line-associated bloodstream infections in Quebec intensive care units: a 6-year review.
机构信息
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
出版信息
Am J Infect Control. 2012 Apr;40(3):221-6. doi: 10.1016/j.ajic.2011.04.008. Epub 2011 Aug 6.
BACKGROUND
The burden of central line-associated bloodstream infections (CLABSI) in Canadian intensive care units (ICUs) is not well established. The present study aimed to describe CLABSI epidemiology in Quebec ICUs during 2003-2009.
METHODS
The study population was a retrospective dynamic cohort of 58 ICUs that participated in the Surveillance Provinciale des Infections Nosocomiales program during 2003-2009. We calculated annual CLABSI incidence rates (IRs), central venous catheter (CVC) utilization ratios, and case-fatality proportions, and described the pathogens involved. We analyzed data using descriptive statistics and standardized incidence ratios.
RESULTS
A total of 891 CLABSIs were identified during 446,137 CVC-days. In 2003-2009, CLABSI IRs were 1.67 CLABSI/1,000 CVC-days in adult ICUs, 2.20 CLABSIs/1,000 CVC-days in pediatric ICUs, and 4.40 CLABSIs/1,000 CVC-days in neonatal ICUs. Since 2007, CLABSI IRs in adult, pediatric and neonatal ICUs have decreased by 11%, 50%, and 18%, respectively. Pediatric ICUs had the highest CVC utilization ratio (median, 0.61; interquartile range, 0.57-0.66). Coagulase-negative staphylococci caused 53% of the CLABSIs. The proportion of methicillin-resistant Staphylococcus aureus declined from 70% to <40% after 2006.
CONCLUSIONS
CLABSIs result in a considerable burden of illness in Quebec ICUs. However, CLABSI IRs have decreased since 2007, and the proportion of methicillin-resistant S aureus has remained <40% since 2006. Continuous surveillance is essential to determine whether these changes are sustainable.
背景
加拿大重症监护病房（ICU）中中心静脉导管相关性血流感染（CLABSI）的负担尚未明确。本研究旨在描述 2003-2009 年魁北克省 ICU 中 CLABSI 的流行病学情况。
方法
研究人群为 2003-2009 年参与省级医院感染监测计划的 58 个 ICU 的回顾性动态队列。我们计算了每年的 CLABSI 发病率（IR）、中心静脉导管（CVC）使用率和病死率，并描述了涉及的病原体。我们使用描述性统计和标准化发病率比分析数据。
结果
在 446,137 个 CVC 日中，共发现 891 例 CLABSI。2003-2009 年，成人 ICU 的 CLABSI IR 为 1.67/1,000 CVC 日，儿科 ICU 为 2.20/1,000 CVC 日，新生儿 ICU 为 4.40/1,000 CVC 日。自 2007 年以来，成人、儿科和新生儿 ICU 的 CLABSI IR 分别下降了 11%、50%和 18%。儿科 ICU 的 CVC 使用率最高（中位数，0.61；四分位距，0.57-0.66）。凝固酶阴性葡萄球菌引起 53%的 CLABSI。耐甲氧西林金黄色葡萄球菌的比例从 2006 年的 70%降至<40%。
结论
CLABSI 在魁北克省 ICU 中导致了相当大的疾病负担。然而，自 2007 年以来，CLABSI IR 有所下降，自 2006 年以来，耐甲氧西林金黄色葡萄球菌的比例一直保持在<40%。连续监测对于确定这些变化是否可持续至关重要。
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