Gross P A, Neu H C, Aswapokee P, Van Antwerpen C, Aswapokee N
Am J Med. 1980 Feb;68(2):219-23. doi: 10.1016/0002-9343(80)90357-5.
To assess the importance of nosocomial infections as a contributory cause of death in patients who die in the hospital, we studied the hospital course of 100 consecutive patients who died at Columbia-Presbyterian Medical Center and 100 consecutive patients who died at Hackensack Hospital. The epidemiologic patterns of infection were similar although the institutions provide care for different types of patients. There were 88 nosocomial infections in 63 patients. When the nosocomial infection was causally related or contributed to death, infection of the lower respiratory tract was predominant in 31 of 52 (60 per cent) instances. When the nosocomial infection was unrelated to death, urinary tract infection was predominant in 13 of 36 (36 per cent) infections. Among those who died with nosocomial infection, 42 of 63 (67 per cent) patients were terminal on admission and were typically in their 60's with metastatic carcinoma. The 21 patients who were not terminal on admission were typically in their late 70's and had complications of arteriosclerotic cardiovascular disease. Pneumonia was the most frequent nosocomial infection related to death. There is need to devise a pneumonia prevention program that identifies those at high risk and reduces the chance of aspiration of pharyngeal secretions and spread of virulent bacteria from person to person.
为评估医院感染作为在医院死亡患者死亡的一个促成因素的重要性，我们研究了在哥伦比亚长老会医学中心死亡的100例连续患者以及在哈肯萨克医院死亡的100例连续患者的住院病程。尽管这些机构为不同类型的患者提供护理，但感染的流行病学模式相似。63例患者发生了88例医院感染。当医院感染与死亡有因果关系或促成死亡时，52例中有31例（60%）下呼吸道感染占主导。当医院感染与死亡无关时，36例感染中有13例（36%）尿路感染占主导。在死于医院感染的患者中，63例中有42例（67%）入院时已处于终末期，通常为60多岁的转移性癌患者。21例入院时未处于终末期的患者通常为70多岁晚期，患有动脉硬化性心血管疾病并发症。肺炎是与死亡相关的最常见医院感染。有必要制定一个肺炎预防计划，该计划能识别高危人群，并减少咽部分泌物误吸以及有毒细菌在人与人之间传播的机会。
