Uwingabiye Jean, Lemnouer Abdelhay, Baidoo Sabina, Frikh Mohammed, Kasouati Jalal, Maleb Adil, Benlahlou Yassine, Bssaibis Fatna, Mbayo Albert, Doghmi Nawfal, Abouelalaa Khalil, Baite Abdelouahed, Ibrahimi Azeddine, Elouennass Mostafa
PharmD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco.
MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco.
Germs. 2017 Dec 5;7(4):193-205. doi: 10.18683/germs.2017.1126. eCollection 2017 Dec.
The objective of this study was to examine the epidemiology, risk factors and outcome associated with infections in the intensive care units (ICUs) in a Moroccan teaching hospital.
This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016.
Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with infection.
Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.
本研究的目的是调查摩洛哥一家教学医院重症监护病房（ICU）感染的流行病学、危险因素及预后情况。
这是一项配对病例对照研究，由临床细菌学部门与穆罕默德五世军事教学医院的两个ICU于2015年1月至2016年7月联合开展。
在入住ICU的964例患者中，81例（8.4%）发生了感染。多因素逻辑回归分析确定了以下ICU获得性感染的独立危险因素：ICU住院时间≥14天（比值比（OR）=6.4）、既往使用中心静脉导管（OR=18）、既往使用机械通气（OR=9.5）、侵入性操作持续时间≥7天（OR=7.8）、既往使用亚胺培南（OR=9.1）、既往使用阿米卡星（OR=5.2）、既往使用联合抗生素治疗（OR=11.8）以及既往使用皮质激素治疗（OR=5）。另一方面，术后护理入院被确定为一个保护因素。感染患者的粗死亡率为74.1%。多因素分析显示，感染患者的感染性休克（OR=19.2）和高龄（≥65岁）（OR=4.9）与死亡风险显著相关。
我们的结果表明，缩短ICU住院时间、合理使用医疗设备以及优化抗菌治疗可降低这些感染的发生率。老年患者和感染性休克患者预后较差。这些发现凸显了关注高危患者以预防这些感染并改善临床结局的必要性。
