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重症监护病房中医疗保健相关性感染的发生率、微生物特征和危险因素:波兰南部一家省级医院的 10 年观察。

Incidence, Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units: A 10 Year Observation in a Provincial Hospital in Southern Poland.

机构信息

The Institute of Health Sciences, State Higher Vocational School in Tarnów, ul. Mickiewicza 8, 33-100 Tarnów, Poland.

Department of Nursing Management and Epidemiology Nursing, Faculty of Health Sciences, Jagiellonian University Medical College, ul. Kopernika 25, 31-501 Kraków, Poland.

出版信息

Int J Environ Res Public Health. 2018 Jan 11;15(1):112. doi: 10.3390/ijerph15010112.

Abstract

Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Aetiological factors of these infections can have an impact on treatment effects, treatment duration and mortality. The aim of the study was to determine the prevalence and microbiological profile of HAIs in patients hospitalized in an ICU over a span of 10 years. The active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a general ICU ward located in southern Poland between 2007 and 2016. The study was conducted in compliance with the methodology recommended by the Healthcare-associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC). During the 10 years of the study, 1849 patients hospitalized in an ICU for a total of 17,599 days acquired 510 with overall HAIs rates of 27.6% and 29.0% infections per 1000 ICU days. Intubation-associated pneumonia (IAP) posed the greatest risk (15.2 per 1000 ventilator days), followed by CLA-BSI (8.0 per 1000 catheter days) and CA-UTI (3.0 per 1000 catheter days). The most common isolated microorganism was (25%) followed by Coagulaase-negativ staphylococci (15%), (9%), (8%), (7%), (6%). in 87% and were classified as extensive-drug resistant (XDR). In summary, in ICU patients pneumonia and bloodstream infections were the most frequently found. strains were most often isolated from clinical materials taken from HAI patients and showed resistance to many groups of antibiotics. A trend of increasing resistance of to carbapenems was observed.

摘要

在重症监护病房(ICU)接受治疗的患者中发生的与医疗保健相关的感染(HAI)是治疗过程中的严重并发症。这些感染的病因因素会影响治疗效果、治疗持续时间和死亡率。本研究的目的是确定在波兰南部一家综合 ICU 病房住院的患者中,HAI 的患病率和微生物学特征,时间跨度为 10 年。采用主动监测方法检测 2007 年至 2016 年期间在波兰南部一家 ICU 病房住院时间超过 48 小时的成年患者的 HAI。该研究是按照欧洲疾病预防和控制中心(ECDC)的医疗保健相关感染监测网络(HAI-Net)推荐的方法进行的。在研究的 10 年中,1849 名患者在 ICU 住院共计 17599 天,共有 510 例患者发生了 HAI,总感染率为 27.6%和 29.0%,每 1000 ICU 天感染 1000 例。与插管相关的肺炎(IAP)的风险最高(每 1000 个呼吸机天发生 15.2 例),其次是导管相关血流感染(CLA-BSI)(每 1000 个导管天发生 8.0 例)和导管相关尿路感染(CA-UTI)(每 1000 个导管天发生 3.0 例)。最常见的分离微生物是 (25%),其次是凝固酶阴性葡萄球菌(15%)、 (9%)、 (8%)、 (7%)、 (6%)。在 87%的情况下,它们被归类为广泛耐药(XDR)。总之,在 ICU 患者中,肺炎和血流感染最为常见。从 HAI 患者的临床标本中分离出的 菌株最为常见,且对许多抗生素组表现出耐药性。观察到对碳青霉烯类药物的耐药性呈上升趋势。

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