Fakih Mohamad G, Groves Clariecia, Bufalino Angelo, Sturm Lisa K, Hendrich Ann L
Care Excellence,Ascension Health,St. Louis,Missouri.
Infect Control Hosp Epidemiol. 2017 Jun;38(6):685-689. doi: 10.1017/ice.2017.41. Epub 2017 Mar 23.
BACKGROUND The National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) definition was revised as of January 2015 to exclude funguria and lower bacteriuria levels. We evaluated the effect of the CAUTI definition change on NHSN-defined central-line-associated bloodstream infection (CLABSI) outcomes. METHODS We compared CAUTI and CLABSI NHSN-defined outcomes for calendar years 2014 and 2015 in the adult intensive care units (ICUs) of a single large health system. Changes in the event rates, the associated organisms, and the standardized infection ratio (SIR) were evaluated. RESULTS The study included 137 adult ICUs from 65 hospitals. The CAUTI SIR dropped from 1.04 in 2014 to 0.58 in 2015 (-44.2%), while the CLABSI SIR increased from 0.36 in 2014 to 0.47 in 2015 (+30.6%). CAUTI rates dropped 44.8% from 2.09 to 1.15 events per 1,000 device days (P<.001). Gram-positive-associated CAUTI rates dropped 36.7% from 0.34 to 0.22 per 1,000 device days (P=.007). CLABSI rates increased 27.1% from 0.71 to 0.90 per 1,000 device days (P=.027). Candida-associated CLABSI increased by 91.1% from 0.104 to 0.198 per 1,000 device days (P=.012), and Enterococcus-associated CLABSI increased by 121.6% from 0.071 to 0.16 per 1,000 device days (P=.008). CONCLUSIONS The revised CAUTI definition led to a large reduction in CAUTI rates and, in turn, an increase in candidemia and enterococcemia cases classified as CLABSI events. These findings have important implications on the perceived successes or failures to eliminate both infections. Infect Control Hosp Epidemiol 2017;38:685-689.
国家医疗安全网络（NHSN）关于导管相关尿路感染（CAUTI）的定义于2015年1月进行了修订，将真菌尿和较低的菌尿水平排除在外。我们评估了CAUTI定义的变化对NHSN定义的中心静脉导管相关血流感染（CLABSI）结果的影响。方法：我们比较了单一大型医疗系统成人重症监护病房（ICU）2014年和2015年日历年中NHSN定义的CAUTI和CLABSI结果。评估了事件发生率、相关病原体以及标准化感染比值（SIR）的变化。结果：该研究纳入了来自65家医院的137个成人ICU。CAUTI的SIR从2014年的1.04降至2015年的0.58（-44.2%），而CLABSI的SIR从2014年的0.36升至2015年的0.47（+30.6%）。CAUTI发生率从每1000个器械日2.09例降至1.15例，下降了44.8%（P<0.001）。革兰阳性菌相关的CAUTI发生率从每1000个器械日0.34例降至0.22例，下降了36.7%（P=0.007）。CLABSI发生率从每1000个器械日0.71例升至0.90例，上升了27.1%（P=0.027）。念珠菌相关的CLABSI从每1000个器械日0.104例增至0.198例，增加了91.1%（P=0.012），肠球菌相关的CLABSI从每1000个器械日0.071例增至0.16例，增加了121.6%（P=0.008）。结论：修订后的CAUTI定义导致CAUTI发生率大幅下降，进而导致归类为CLABSI事件的念珠菌血症和肠球菌血症病例增加。这些发现对消除这两种感染的成败认知具有重要意义。《感染控制与医院流行病学》2017年；38：685 - 689。
