Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Research Development Unit, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran.
BMC Public Health. 2021 Apr 24;21(1):787. doi: 10.1186/s12889-021-10857-y.
Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran's hospitals.
Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father's name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020.
The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI.
Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.
医院获得性感染（HAIs）是住院患者发病率和死亡率的一个已知原因。本研究旨在调查伊朗医院重症监护病房（ICU）获得性感染（ICU-AIs）患者的生存率及其相关因素。
数据来自伊朗医院感染监测（INIS），该监测系统登记了来自每个纳入医院不同科室的主要感染类型的所有必要信息。通过使用姓名、父亲的名字、年龄、医院代码、感染代码和卧床日期等变量，从分析中排除了 1134 例重复病例。2016 年至 2019 年期间，从大约 547 家医院诊断出 32998 例 ICU-AI 患者。所有患者均随访至 2020 年 2 月 29 日。
ICU-AI 患者的中位年龄为 61（IQR=46）岁。普通、外科、内科、新生儿和儿科 ICU 的感染分别为 45.5%、20.69%、17.63%、12.08%和 4.09%。不动杆菌（16.52%）、大肠杆菌（12.01%）和克雷伯菌（9.93%）是主要的微生物类型。在总感染患者中，40.76%（13449 例）死亡。ICU-AI 患者的 1、3、6 个月和总生存率分别为 70%、25.72%、8.21%和 1.48%。外科、普通、内科、新生儿和儿科 ICU 的总生存率分别为 5.12%、1.34%、0.0%、51.65%和 31.08%。风险比显示，年龄、住院-感染时间、感染类型和微生物与 ICU-AI 患者死亡风险之间存在显著关系。
根据结果，医院感染监测系统似乎应该更加智能化。这种智能应该根据患者年龄、住院-感染时间、感染类型、微生物和病房类型等相关因素，采取不同的措施。换句话说，该系统应该能够根据识别、干预和采取措施防止 HAIs 传播的影响生存率的因素，基于严重程度风险系统，动态提供必要和及时的警报。
