Wałaszek Michał, Różańska Anna, Bulanda Małgorzata, Wojkowska-Mach Jadwiga
Polish Society of Hospital Infections, Krakow, Poland
Chair of Microbiology in Jagiellonian University Medical College, Krakow, Poland
Przegl Epidemiol. 2018;72(1):33-44.
Nosocomial bloodstream infections (BSI) among patients in intensive care units (ICU) are the most common form of nosocomial infections and they are serious complications of the treatment process. The etiological factors of these infections and the proper antibiotic therapy can influence the effects of patient treatment. The aim of the study was to analyze the epidemiology, microbiology and antibiotic therapy of nosocomial BSI in Polish ICU patients.
The retrospective study covered patients hospitalized in seven ICUs for adults with a general profile, located in southern Poland. The studied units participated in a multicentre standardized infection control program in 2013-2015. 2,547 patients hospitalized more than 48 hours in ICUs were qualified to the study. The study was conducted in accordance with the methodology recommended by the European Center for Disease Prevention and Control (ECDC) as part of the European Healthcare-Associated Infections Surveillance Network (HAI-Net): protocols and the criteria for BSI recognition were standardized.
The incidence of BSI was 7.2% per 100 admissions and the incidence density was 9.2 per 1000 persondays of hospitalization. Among 184 BSI cases, 65 cases (35.3%) were primary BSI; 87 cases were secondary BSI (47.3%) (related to an infection occurring elsewhere in the patient’s body), the remaining 32 cases (17.4%) were classified as BSI of unknown origin. Mortality was 20%. The dominant etiological factors in BSI related to central venous catheter were coagulase-negative staphylococci in 20.8% of cases, but in secondary BSI it was Acinetobacter baumannii in 34.5% of cases. Klebsiella pneumoniae showed resistance to third-generation cephalosporins in 96.0% of cases; Acinetobacter baumannii showed resistance to imipenem in 78.8% of cases. Other beta-lactam antibiotics J01D (31.0%) and other antibiotics J01X (26.6%) were most commonly used in the treatment.
The BSI incidence in the studied Polish ICUs was twice as high as in other European countries, and secondary BSI were also more frequent – especially secondary to urinary tract infections. The obtained results indicate the necessity of intervention not only in BSI prevention, but also in the field of prevention of urinary tract infections. In addition, microbial etiology and drug resistance indicate the need for urgent actions for their prevention.
重症监护病房（ICU）患者的医院血流感染（BSI）是医院感染最常见的形式，也是治疗过程中的严重并发症。这些感染的病因及适当的抗生素治疗会影响患者的治疗效果。本研究旨在分析波兰ICU患者医院BSI的流行病学、微生物学及抗生素治疗情况。
这项回顾性研究涵盖了波兰南部七家收治成年普通患者的ICU中的住院患者。研究单位于2013 - 2015年参与了一项多中心标准化感染控制项目。2547名在ICU住院超过48小时的患者被纳入研究。该研究按照欧洲疾病预防控制中心（ECDC）作为欧洲医疗相关感染监测网络（HAI - Net）一部分所推荐的方法进行：BSI识别的方案和标准均已标准化。
BSI的发病率为每100例入院患者中有7.2%，发病密度为每1000住院人日中有9.2例。在184例BSI病例中，65例（35.3%）为原发性BSI；87例为继发性BSI（47.3%）（与患者身体其他部位发生的感染相关），其余32例（17.4%）被归类为来源不明的BSI。死亡率为20%。与中心静脉导管相关的BSI的主要病因中，凝固酶阴性葡萄球菌在20.8%的病例中占主导，但在继发性BSI中，鲍曼不动杆菌在34.5%的病例中占主导。肺炎克雷伯菌对第三代头孢菌素的耐药率为96.0%；鲍曼不动杆菌对亚胺培南的耐药率为78.8%。治疗中最常用的是其他β - 内酰胺类抗生素J01D（31.0%）和其他抗生素J01X（26.6%）。
所研究的波兰ICU中BSI的发病率是其他欧洲国家的两倍，继发性BSI也更常见——尤其是继发于尿路感染。所得结果表明不仅有必要对BSI的预防进行干预，而且在尿路感染预防领域也有必要进行干预。此外，微生物病因和耐药性表明需要采取紧急措施来预防它们。
