美国重症儿童的医疗保健相关性感染，2007-2012 年。
Health care-associated infections among critically ill children in the US, 2007-2012.
机构信息
Department of Pediatrics, and Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee;
Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts;
出版信息
Pediatrics. 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613. Epub 2014 Sep 8.
BACKGROUND
Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012.
METHODS
In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates.
RESULTS
A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs.
CONCLUSIONS
Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.
背景
医疗保健相关感染（HAIs）对住院儿童的危害和成本都很大，会导致其发病率大幅上升；然而，目前对于新生儿和儿科人群中 HAI 的全国性趋势知之甚少。我们的目的是确定 2007 年至 2012 年期间美国大量危重病儿童治疗医院中 HAI 的发病率。
方法
在这项队列研究中，我们纳入了向疾病控制与预防中心国家医疗保健安全网络报告数据的医院中的新生儿重症监护病房（NICU）和儿科重症监护病房（PICU），以报告与中心静脉置管相关的血流感染（CLABSI）、呼吸机相关性肺炎和导管相关性尿路感染。我们使用时间序列设计来评估 HAI 率的变化。
结果
共有 173 家美国医院提供了来自 NICU 的数据，64 家提供了来自 PICU 的数据。2007 年至 2012 年，NICU 的 CLABSI 发生率从每千中心静脉置管天数 4.9 例降至 1.5 例（每季度发病率比为 0.96，95%置信区间为 0.94-0.97），PICU 从每千中心静脉置管天数 4.7 例降至 1.0 例（每季度发病率比为 0.96 [0.94-0.98]）。NICU 的呼吸机相关性肺炎发生率从每千呼吸机天数 1.6 例降至 0.6 例（每季度发病率比为 0.97 [0.93-0.99]），PICU 从每千呼吸机天数 1.9 例降至 0.7 例（每季度发病率比为 0.95 [0.92-0.98]）。PICU 中导管相关性尿路感染的发生率没有明显变化。
结论
2007 年至 2012 年间，住院新生儿和儿童的 HAI 大幅减少。
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