2000-2008 年台湾一家三级医疗中心重症监护病房装置相关感染发病率和死亡率的长期趋势监测：一项回顾性观察研究。

Surveillance on secular trends of incidence and mortality for device-associated infection in the intensive care unit setting at a tertiary medical center in Taiwan, 2000-2008: a retrospective observational study.

机构信息

Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

BMC Infect Dis. 2012 Sep 10;12:209. doi: 10.1186/1471-2334-12-209.

DOI:10.1186/1471-2334-12-209

PMID:22963041

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3458996/

Abstract

BACKGROUND

Device-associated infection (DAI) plays an important part in nosocomial infection. Active surveillance and infection control are needed to disclose the specific situation in each hospital and to cope with this problem effectively. We examined the rates of DAI by antimicrobial-resistant pathogens, and 30-day and in-hospital mortality in the intensive care unit (ICU).

METHODS

Prospective surveillance was conducted in a mixed medical and surgical ICU at a major teaching hospital from 2000 through 2008. Trend analysis was performed and logistic regression was used to assess prognostic factors of mortality.

RESULTS

The overall rate of DAIs was 3.03 episodes per 1000 device-days. The most common DAI type was catheter-associated urinary tract infection (3.76 per 1000 urinary catheter-days). There was a decrease in DAI rates in 2005 and rates of ventilator-associated pneumonia (VAP, 3.18 per 1000 ventilator-days) have remained low since then (p < 0.001). The crude rates of 30-day (33.6%) and in-hospital (52.3%) mortality, as well as infection by antibiotic-resistant VAP pathogens also decreased. The most common antimicrobial-resistant pathogens were methicillin-resistant Staphylococcus aureus (94.9%) and imipenem-resistant Acinetobacter baumannii (p < 0.001), which also increased at the most rapid rate. The rate of antimicrobial resistance among Enterobacteriaceae also increased significantly (p < 0.05). After controlling for potentially confounding factors, the DAI was an independent prognostic factor for both 30-day mortality (OR 2.51, 95% confidence interval [CI] 1.99-3.17, p = 0.001) and in-hospital mortality (OR 3.61, 95% CI 2.10-3.25, p < 0.001).

CONCLUSIONS

The decrease in the rate of DAI and infection by resistant bacteria on the impact of severe acute respiratory syndrome can be attributed to active infection control and improved adherence after 2003.

摘要

背景

器械相关感染（DAI）在医院感染中起着重要作用。需要主动监测和感染控制来揭示每家医院的具体情况，并有效应对这一问题。我们检查了由抗菌药物耐药病原体引起的 DAI 发生率，以及重症监护病房（ICU）的 30 天和住院死亡率。

方法

2000 年至 2008 年，在一家主要教学医院的混合内科和外科 ICU 进行前瞻性监测。进行趋势分析，并使用逻辑回归评估死亡率的预后因素。

结果

总的 DAI 发生率为每 1000 个器械日 3.03 例。最常见的 DAI 类型是导管相关尿路感染（每 1000 个导尿管日 3.76 例）。2005 年 DAI 发生率下降，此后呼吸机相关性肺炎（VAP，每 1000 个呼吸机日 3.18 例）的发生率一直较低（p <0.001）。30 天（33.6%）和住院（52.3%）死亡率以及耐抗生素 VAP 病原体感染的粗率也有所下降。最常见的抗微生物耐药病原体是耐甲氧西林金黄色葡萄球菌（94.9%）和耐亚胺培南鲍曼不动杆菌（p <0.001），这两种病原体的上升速度也最快。肠杆菌科的抗微生物药物耐药率也显著增加（p <0.05）。在控制潜在混杂因素后，DAI 是 30 天死亡率（OR 2.51，95%置信区间[CI] 1.99-3.17，p = 0.001）和住院死亡率（OR 3.61，95% CI 2.10-3.25，p <0.001）的独立预后因素。