2020 年 COVID-19 大流行期间，德国重症监护病房并未出现与设备相关的感染增加。
No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020.
机构信息
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Hindenburgdamm 27, 12203, Berlin, Germany.
National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany.
出版信息
Antimicrob Resist Infect Control. 2022 May 7;11(1):67. doi: 10.1186/s13756-022-01108-9.
BACKGROUND
The COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019.
METHODS
We utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019-2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models.
RESULTS
The number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed.
CONCLUSIONS
The lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.
背景
COVID-19 大流行可能对设备相关的医疗保健相关感染（HAI）的发生率产生重大影响，尤其是在重症监护病房（ICU）中。与 2019 年相比，美国医院报告了 HAI 的显著增加。本研究的目的是调查 2020 年德国 ICU 中与设备相关的最相关 HAI 的发展情况，与 2019 年进行比较。
方法
我们使用了德国国家医院感染监测中心（KISS=Krankenhaus-Infektions-Surveillance-System）的 ICU 部分的 2019-2020 年的数据。我们重点关注中心静脉置管相关血流感染（CLABSI）、导管相关尿路感染（CAUTI）、呼吸机相关下呼吸道感染（VALRTI）和体外生命支持系统（ECLSABSI）使用相关的血流感染。设备使用定义为每 100 个患者天的设备天数；设备相关感染率定义为每 1000 个设备天的设备相关感染数。为了比较年度和季度之间的汇总平均值，我们通过泊松回归模型计算了设备相关感染率的率比及其 95%置信区间。
结果
参与监测系统的 ICU 数量从 2019 年的 982 家减少到 2020 年的 921 家（6.2%）。中心静脉置管和呼吸机的设备使用率显著增加。与 2019 年相比，2020 年 VALRTI 率和 CAUTI 率下降，但 CLABSI 或 ECLSABSI 率没有增加。当分析相应的年度季度时，也得到了同样的结果。
结论
德国 ICU 中设备相关医疗保健相关感染（HAI）没有增加，这可能是由于德国 2020 年 COVID-19 病例的总体发病率低于美国，每 10 万居民 ICU 床位的可用性非常高，与许多其他国家相比，以及由于第一波和第二波期间许多择期手术的推迟而导致 ICU 患者构成发生变化。主要原因似乎是 2020 年德国只有 7%的 ICU 患者是 COVID-19 患者。
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