Laborde G, Grosskopf U, Schmieder K, Harders A, Klimek L, Hardenack M, Gilsbach J M
Klinik und Praxis für Neurochirurgie, Paracelsus Klinik, Osnabrück.
Anaesthesist. 1993 Oct;42(10):724-31.
The occurrence of nosocomial infections in 1017 consecutive patients seen in a neurosurgical intensive care unit (ICU), over a period of 18 months is reported. The frequency of infections is low, which may possibly be due partly to the short stay in the ICU. Close interdisciplinary cooperation is stressed as an important factor in limiting infections. BACKGROUND. The aim of this study was to analyse the nosocomial infections in a neurosurgical intensive care unit over a period of 18 months, emphasizing localization and cause of infection, in order to adapt treatment and to take preventive measures. From 15% to 27% of patients treated in ICUs acquire nosocomial infections. In Germany this means 500,000-800,000 patients a year, and the annual costs related to nosocomial infections are estimated at 1.7 billion Deutschmarks. PATIENTS AND METHODS. In all, 1017 consecutive patients were evaluated. The patients were divided into two groups, depending on the duration of treatment in the ICU: Patients who remained for less than 48 h (1017 patients) Patients who were treated for a period exceeding 48 h (314 patients) The evaluation was performed retrospectively from the medical documentation. Criteria for registration are those of the Centers for Disease Control (Atlanta 1988). When more than one infection was diagnosed, each was considered as a new infection, regardless of the bacteria involved. Among the 314 patients who were in the ICU for more than 48 h a total of 114 nosocomial infections were recorded. The frequency of infection referred to all patients treated during that time (n = 1017) was 11.2%, while the frequency among those who were treated for longer than 48 h was 36.3%. Most infections (38.6%) affected the respiratory tract, followed by infections of the urinary tract. Of the bacteria determined 56.7% were gram-negative. In this group E. coli was the most frequently found (29.8%). In the group of gram-positive bacteria, S. aureus was diagnosed in 56.3% of cases. Twelve (16%) of the infected patients died and lethality referred to all patients was 8.6%. DISCUSSION. Compared with other studies, this study revealed a low the infection rate, at 11.2%. This can be explained partly by the short stay in this ICU (mean 3.7 days) and partly by the retrospective method of registration and the particular medical characteristics of neurosurgical patients. The well-known general risk factors for infection, such as age, mechanical ventilation, continuous catheterization of the bladder, and long duration of stay, are also found in neurosurgical ICUs. It is quite difficult to determine to what extent nosocomial infections prolong the treatment necessitated by the primary neurosurgical disease. We were not able to extrapolate the influence of immunosuppressant treatment on the appearance of nosocomial infections, as almost all patients in this study were receiving steroids. This study underlines the necessity of interdisciplinary cooperation between neurosurgeons, anaesthesiologists, microbiologists and nurses in neurosurgical ICUs, where most patients staying longer than 48 h are immunosuppressed and ventilated and thereby particularly at risk of nosocomial infections.
本文报告了在18个月期间，神经外科重症监护病房（ICU）连续收治的1017例患者医院感染的发生情况。感染发生率较低，这可能部分归因于患者在ICU的停留时间较短。强调密切的多学科合作是限制感染的重要因素。背景。本研究的目的是分析神经外科重症监护病房18个月期间的医院感染情况，重点关注感染的部位和原因，以便调整治疗方案并采取预防措施。在ICU接受治疗的患者中，有15%至27%会发生医院感染。在德国，这意味着每年有50万至80万患者，与医院感染相关的年度费用估计为17亿德国马克。患者与方法。总共对1017例连续患者进行了评估。根据患者在ICU的治疗时长，将患者分为两组：在ICU停留时间少于48小时的患者（1017例）在ICU治疗时间超过48小时的患者（314例）评估是通过回顾医疗记录进行的。登记标准采用疾病控制中心（亚特兰大，1988年）的标准。当诊断出多种感染时，每种感染都被视为一种新感染，无论涉及何种细菌。在314例在ICU停留超过48小时的患者中，共记录了114例医院感染。以那段时间内所有接受治疗的患者（n = 1017）计算，感染发生率为11.2%，而在治疗时间超过48小时的患者中，感染发生率为36.3%。大多数感染（38.6%）影响呼吸道，其次是泌尿系统感染。在已确定的细菌中，56.7%为革兰氏阴性菌。在这一组中，大肠杆菌最常见（29.8%）。在革兰氏阳性菌组中，56.3%的病例诊断为金黄色葡萄球菌。12例（16%）感染患者死亡，所有患者的死亡率为8.6%。讨论。与其他研究相比，本研究显示感染率较低，为11.2%。这部分可以通过该ICU患者的短停留时间（平均3.7天）来解释，部分也可以通过回顾性登记方法以及神经外科患者的特殊医学特征来解释。神经外科ICU中也存在众所周知的感染一般风险因素，如年龄、机械通气、膀胱持续插管以及停留时间长等。很难确定医院感染在多大程度上延长了原发性神经外科疾病所需的治疗时间。我们无法推断免疫抑制治疗对医院感染发生的影响，因为本研究中几乎所有患者都在接受类固醇治疗。本研究强调了神经外科ICU中神经外科医生、麻醉医生、微生物学家和护士之间多学科合作的必要性，在该科室中，大多数停留时间超过48小时的患者都处于免疫抑制状态且需要通气，因此特别容易发生医院感染。
