Vincent J L, Bihari D J, Suter P M, Bruining H A, White J, Nicolas-Chanoin M H, Wolff M, Spencer R C, Hemmer M
Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
JAMA. 1995;274(8):639-44.
To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality.
A 1-day point-prevalence study.
Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units.
All patients (> 10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports.
Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death.
A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported micro-organisms were Enterobacteriaceae (34.4%), Staphylococcus aureus (30.1%;[60% resistant to methicillin], Pseudomonas aeruginosa (28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (> 48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval[Cl], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% Cl, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% Cl, 1.25 to 2.41) increased the risk of ICU death.
ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients.
确定重症监护病房（ICU）获得性感染的患病率及其危险因素，识别主要感染病原体，并评估ICU获得性感染与死亡率之间的关系。
为期1天的现患率研究。
西欧17个国家的重症监护病房，不包括冠心病监护病房以及儿科和婴儿特殊护理病房。
在24小时内占用ICU床位的所有患者（年龄>10岁）。共有1417个ICU提供了10038份患者病例报告。
ICU获得性感染率、抗菌药物处方、微生物分离株的耐药模式，以及ICU获得性感染和死亡的潜在危险因素。
共有4501例患者（44.8%）发生感染，2064例（20.6%）发生ICU获得性感染。报告的ICU感染最常见类型为肺炎（46.9%）、下呼吸道感染（17.8%）、尿路感染（17.6%）和血流感染（12%）。最常报告的微生物是肠杆菌科（34.4%）、金黄色葡萄球菌（30.1%；[60%对甲氧西林耐药]）、铜绿假单胞菌（28.7%）、凝固酶阴性葡萄球菌（19.1%）和真菌（17.1%）。确定了7个ICU获得性感染的危险因素：ICU住院时间延长（>48小时）、机械通气、创伤诊断、中心静脉置管、肺动脉置管和导尿，以及应激性溃疡预防。ICU获得性肺炎（比值比[OR]，1.91；95%置信区间[Cl]，1.6至2.29）、临床脓毒症（OR，3.50；95%Cl，1.71至7.18）和血流感染（OR，1.73；95%Cl，1.25至2.41）增加了ICU死亡风险。
ICU获得性感染很常见，且常与耐药微生物分离株相关。对结局的潜在影响强调了对危重症患者采取特定感染控制措施的重要性。
