Nursing Department, National and Kapodistrian University of Athens, Greece.
Am J Crit Care. 2013 May;22(3):e12-20. doi: 10.4037/ajcc2013324.
Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients' morbidity and mortality and the costs of patient care.
To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece.
A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality.
During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI, 29.3-38.6). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI.
High rates of DA-HAIs, device utilization, and antimicrobial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies.
多项研究表明，器械相关和医疗保健相关感染（DA-HAI）会影响重症监护病房的护理质量，增加患者的发病率和死亡率，并增加患者护理的成本。
评估希腊雅典 3 家重症监护病房的 DA-HAI 发生率、微生物谱、抗菌药物耐药性和粗死亡率。
2009 年 7 月至 2010 年 6 月，在希腊的 3 家重症监护病房进行了一项前瞻性队列、主动 DA-HAI 监测研究。计算了机械通气相关性肺炎（VAP）、中心导管相关性血流感染（CLABSI）和导管相关性尿路感染（CAUTI）的发生率，以及微生物谱、抗菌药物耐药性和粗死亡率。
在重症监护 6004 天期间，294 名患者中有 152 名患者发生了 205 例 DA-HAI，总发生率为 51.7%的患者或每 1000 天发生 34.1 例 DA-HAI（95%CI，29.3-38.6）。VAP 发生率为每 1000 通气日 20 例（95%CI，16.3-23.7），CLABSI 发生率为每 1000 导管日 11.8 例（95%CI：9.2-14.8），CAUTI 发生率为每 1000 导管日 4.2 例（95%CI，2.5-5.9）。CLABSI 患者中最常分离的病原体是鲍曼不动杆菌（37.8%），CAUTI 患者中最常分离的病原体是念珠菌属（66.7%）。VAP 和 CLABSI 的超额死亡率为 20.3%，耐碳青霉烯类鲍曼不动杆菌 CLABSI 的超额死亡率为 32.2%。
高 DA-HAI 发生率、器械使用率和抗菌药物耐药性强调了需要进行抗菌药物管理、建立主动的 DA-HAI 监测计划以及实施基于证据的预防策略。
