Wilson T, Nolte D, Omar S
Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Anaesthesiology, Nelson Mandela Children's Hospital, Johannesburg, South Africa.
South Afr J Crit Care. 2024 Jul 17;40(2):e1906. doi: 10.7196/SAJCC.2024.v40i2.1906. eCollection 2024.
Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes.
To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods.
This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients.
We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47).
High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.
Hospital-acquired infections are a common problem and cause of morbidity and mortality in intensive care units and general wards globally. However, there is very little literature on the topic from low- and middle-income countries. This study aims to provide insite into the unique factors that contribute to these infections in the South African context.
医疗保健相关感染（HAI）是全球范围内的一个主要问题，会导致住院时间延长和不良后果。
研究重症监护病房（ICU）在高占用率与低占用率期间的HAI发生率及危险因素。
这项回顾性描述性分析调查了在高占用率（H2019）和低占用率（L2020）期间入住克里斯·哈尼·巴拉干纳特医院（CHBH）ICU的成年患者的HAI发生率。数据从440例符合条件的患者的临床记录中提取。
我们发现与L2020相比，H2019期间HAI风险增加（相对风险（RR）1.42，95%置信区间（CI）1.03 - 1.94）。HAI的总体频率密度为每1000个ICU日25例。感染部位（血液与其他部位）分布（p = 0.27）或细菌类别（革兰氏染色）（p = 0.62）无差异。五种微生物占病原体的89%：克雷伯菌（26%）；葡萄球菌（21%）；不动杆菌（16%）；念珠菌（16%）；肠杆菌（10%）。与L2020相比，H2019期间多重耐药/广泛耐药（MDR/XDR）微生物的发生率高4.2倍（95% CI 1.3 - 13.4）。逻辑回归分析显示医院感染的两个独立预测因素：ICU住院时间（比值比（OR）1.12，95% CI 1.02 - 1.22）和肋间引流天数（OR 1.27，95% CI 1.09 - 1.47）。
ICU高占用率与HAI风险增加以及MDR和XDR病原体的更高发生率相关。ICU住院时间延长和侵入性器械使用时间是HAI的独立预测因素。
医院获得性感染是全球重症监护病房和普通病房中常见的问题及发病和死亡原因。然而，来自低收入和中等收入国家关于该主题的文献非常少。本研究旨在深入了解在南非背景下导致这些感染的独特因素。
