Metsini Aliki, Vazquez Miriam, Sommerstein Rami, Marschall Jonas, Voide Cathy, Troillet Nicolas, Gardiol Céline, Pittet Didier, Zingg Walter
Infection Control Programme and WHO Collaborating Centre for Patient Safety; University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Swiss Med Wkly. 2018 Apr 26;148:w14617. doi: 10.4414/smw.2018.14617. eCollection 2018.
The overall burden of healthcare-associated infections (HAIs) remains high, even in high-income countries. However, the current burden of HAI in Switzerland is unknown. Prevalence surveys have a long tradition in the field of infection prevention and control for measuring both HAI and antimicrobial use. The objective of this survey was to test the point prevalence survey (PPS) methodology of the European Centre for Disease Prevention and Control (ECDC) in acute-care hospitals in Switzerland.
Two tertiary care hospitals and one secondary care hospital in central and western Switzerland participated in the survey. Patients from all wards except for emergency departments and psychiatric wards were included. Data were collected on a single day for every ward with a maximum time frame of 2 weeks for completing data collection. Methodology and definitions were based on the most recent ECDC PPS protocol.
Data on a total of 2421 patients were analysed. One hundred thirty-six patients had 153 HAIs, corresponding to a prevalence of 5.6% (95% confidence interval [CI] 4.7-6.5%). Rapidly fatal McCabe score, hospitalisation in the intensive care unit (ICU), and having a medical device in place were independent risk factors for HAI. Lower respiratory tract infection was the most frequent HAI type (24.8%), followed by surgical site infection (22.2%), bloodstream infection (17.0%) and urinary tract infection (13.7%). The highest HAI prevalence (26.2%) was observed in the ICU. In total, 60.8% of all HAIs were microbiologically confirmed. The most common microorganism was Escherichia coli (21.1%). Six hundred sixty-nine patients (27.6%, 95% CI 25.9-29.4%) received 893 antimicrobials for 705 indications. Community-acquired infections (39.0%) were the most common indication for antimicrobial use and amoxicillin-clavulanate was the most commonly prescribed antimicrobial (18.4%).
HAI prevalence and antimicrobial use in this survey were similar to findings of the past ECDC PPS. The ECDC methodology proved applicable to Swiss acute-care hospitals.
即使在高收入国家，医疗保健相关感染（HAIs）的总体负担仍然很高。然而，瑞士目前HAI的负担尚不清楚。患病率调查在感染预防和控制领域有着悠久的传统，用于测量HAI和抗菌药物的使用情况。本次调查的目的是在瑞士的急症医院测试欧洲疾病预防控制中心（ECDC）的现患率调查（PPS）方法。
瑞士中部和西部的两家三级护理医院和一家二级护理医院参与了此次调查。纳入了除急诊科和精神科病房以外所有病房的患者。在一天内为每个病房收集数据，完成数据收集的最长时间框架为2周。方法和定义基于最新的ECDC PPS方案。
共分析了2421例患者的数据。136例患者发生了153例HAI，患病率为5.6%（95%置信区间[CI]4.7 - 6.5%）。快速致命的麦凯布评分、在重症监护病房（ICU）住院以及使用医疗设备是HAI的独立危险因素。下呼吸道感染是最常见的HAI类型（24.8%），其次是手术部位感染（22.2%）、血流感染（17.0%）和尿路感染（13.7%）。在ICU中观察到最高的HAI患病率（26.2%）。所有HAI中，60.8%经微生物学证实。最常见的微生物是大肠杆菌（21.1%）。669例患者（27.6%，95%CI 25.9 - 29.4%）因705种适应症接受了893种抗菌药物治疗。社区获得性感染（39.0%）是抗菌药物使用最常见的适应症，阿莫西林 - 克拉维酸是最常用的抗菌药物（18.4%）。
本次调查中HAI的患病率和抗菌药物使用情况与过去ECDC PPS的结果相似。ECDC方法被证明适用于瑞士的急症医院。
