Craven D E, Kunches L M, Lichtenberg D A, Kollisch N R, Barry M A, Heeren T C, McCabe W R
Department of Medicine, Boston University School of Medicine, MA.
Arch Intern Med. 1988 May;148(5):1161-8.
We prospectively studied 526 patients admitted to the medical intensive care unit (MICU) and 799 patients admitted to the surgical intensive care unit (SICU) at a municipal hospital over a 20-month period. Rates of nosocomial infection were higher in the SICU patients (31% vs 24%). The SICU patients had more urinary tract infections, bacteremias, and wound infections, and the MICU patients were older, had higher acute physiology scores on admission and were more often admitted with shock or coma. The SICU patients were more likely to have received prior antibiotic therapy and had significantly higher numbers of endotracheal tubes, arterial lines, central venous lines, and indwelling bladder catheters. Of the 23 variables univariately associated with nosocomial infection, only five remained significant after entry into step-wise regression models. The MICU patients had a higher fatality rate in the MICU than did the SICU patients (18% vs 10%), but the relative risk of a death following nosocomial infection was 3.5 for both groups. Thirty variables were significantly associated with hospital fatality; nine remained significant after analysis by stepwise logistic regression.
在20个月的时间里，我们对一家市级医院内科重症监护病房（MICU）收治的526例患者和外科重症监护病房（SICU）收治的799例患者进行了前瞻性研究。SICU患者的医院感染率更高（31%对24%）。SICU患者有更多的尿路感染、菌血症和伤口感染，而MICU患者年龄更大，入院时急性生理学评分更高，且更常因休克或昏迷入院。SICU患者更有可能接受过先前的抗生素治疗，并且气管内插管、动脉导管、中心静脉导管和留置膀胱导管的数量明显更多。在单变量分析中与医院感染相关的23个变量中，只有5个在进入逐步回归模型后仍具有显著性。MICU患者在MICU中的死亡率高于SICU患者（18%对10%），但两组医院感染后的死亡相对风险均为3.5。30个变量与医院死亡率显著相关；经逐步逻辑回归分析后，9个变量仍具有显著性。
