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印度新德里一家三级医院重症监护病房医疗器械相关和卫生保健相关感染的前瞻性监测。

Prospective surveillance of device-associated health care-associated infection in an intensive care unit of a tertiary care hospital in New Delhi, India.

机构信息

Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.

Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.

出版信息

Am J Infect Control. 2018 Feb;46(2):202-206. doi: 10.1016/j.ajic.2017.08.037. Epub 2017 Oct 16.


DOI:10.1016/j.ajic.2017.08.037
PMID:29046215
Abstract

BACKGROUND: Surveillance of health care-associated infections (HAIs) plays a key role in the hospital infection control program and reduction of HAIs. In India, most of the surveillance of HAIs is reported from private sector hospitals that do not depict the situation of government sector hospitals. Other studies do not confirm with the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) surveillance criterion, or deal with ventilator-associated pneumonia (VAP) instead of ventilator-associated event (VAE). The aim of this study was to identify the incidences of 3 device-associated HAIs (DA-HAIs) (VAE, central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) by active surveillance using CDC's NHSN surveillance criteria and to identify the pathogens associated with these DA-HAIs. METHODS: This was a prospective surveillance study (January 2015-December 2016) conducted in an intensive care unit (ICU) of a large, tertiary care, government hospital situated in Delhi, India. Targeted surveillance was done as per the CDC's NHSN 2016 surveillance criteria. RESULTS: There were 343 patients admitted to the ICU that were included in the study. The surveillance data was reported over 3,755 patient days. A DA-HAIs attack rate of 20.1 per 100 admissions and incidence of 18.3 per 1,000 patient days was observed. The duration of use for each device for patients with DA-HAIs was significantly longer than for patients without DA-HAIs. The device utilization ratios of central line, ventilator, and urinary catheters were 0.57, 0.85, and 0.72, respectively. The crude excess length of stay for patients with DA-HAI was 13 days, and crude excess mortality rate was 11.8%. VAE, CLABSI, and CAUTI rates were 11.8, 7.4, and 9.7 per 1,000 device days, respectively. Among 69 DA-HAIs reported, pathogens could be identified for 49 DA-HAI cases. Klebsiella spp was the most common organism isolated, accounting 28.5% for all DA-HAI cases, followed by Enterococcus spp (24.4%). The most common organisms causing VAE, CAUTI, and CLABSI were Acinetobacter (6/15, 40%), Enterococcus spp (11/31, 35.4%), and Candida spp (5/19, 26.3%), respectively. Most of the gram-negative organisms were carbapenem resistant; however, none of the isolates were colistin resistant. CONCLUSIONS: To reduce the risk of infection in hospitalized patients, DA-HAI surveillance is of primary importance because it effectively describes and addresses the importance and characteristics of the threatening situation created by DA-HAIs. The present surveillance shows high rates of ICU-onset DA-HAIs and high resistance patterns of organisms causing HAIs, representing a major risk to patient safety.

摘要

背景:对医疗相关感染(HAI)的监测在医院感染控制计划和减少 HAI 方面发挥着关键作用。在印度,大多数 HAI 的监测报告来自私营部门医院,这些医院并不能反映政府部门医院的情况。其他研究与疾病控制和预防中心(CDC)的国家医疗保健安全网络(NHSN)监测标准不一致,或者处理呼吸机相关性肺炎(VAP)而不是呼吸机相关性事件(VAE)。本研究旨在通过使用 CDC 的 NHSN 监测标准进行主动监测,确定 3 种器械相关 HAI(DA-HAI)(VAE、中心静脉导管相关血流感染 [CLABSI]和导管相关尿路感染 [CAUTI])的发生率,并确定与这些 DA-HAI 相关的病原体。

方法:这是一项在印度德里的一家大型三级政府医院的重症监护病房(ICU)进行的前瞻性监测研究(2015 年 1 月至 2016 年 12 月)。根据 CDC 的 NHSN 2016 监测标准进行有针对性的监测。

结果:共有 343 名入住 ICU 的患者纳入研究。监测数据报告了 3755 患者天。观察到 DA-HAI 的发病率为 20.1/100 入院和 18.3/1000 患者天。发生 DA-HAI 的患者使用每种器械的时间明显长于未发生 DA-HAI 的患者。中心静脉导管、呼吸机和导尿管的器械使用率分别为 0.57、0.85 和 0.72。发生 DA-HAI 的患者的超额住院天数为 13 天,超额死亡率为 11.8%。VAE、CLABSI 和 CAUTI 的发生率分别为 11.8、7.4 和 9.7/1000 器械天。在报告的 69 例 DA-HAI 中,49 例 DA-HAI 病例可确定病原体。肺炎克雷伯菌是最常见的分离菌,占所有 DA-HAI 病例的 28.5%,其次是肠球菌属(24.4%)。引起 VAE、CAUTI 和 CLABSI 的最常见病原体是不动杆菌(6/15,40%)、肠球菌属(11/31,35.4%)和念珠菌属(5/19,26.3%)。大多数革兰氏阴性菌对碳青霉烯类耐药;然而,没有分离株对粘菌素耐药。

结论:为了降低住院患者感染的风险,DA-HAI 监测至关重要,因为它可以有效地描述和解决由 DA-HAI 引起的威胁情况的重要性和特征。本监测显示 ICU 发生的 DA-HAI 发生率较高,引起 HAI 的病原体耐药模式较高,对患者安全构成重大风险。

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