Hauer T, Lacour M, Gastmeier P, Schulgen G, Schumacher M, Rüden H, Daschner F
Institut für Umweltmedizin und Krankenhaushygiene der Albert-Ludwigs-Universität Freiburg.
Med Klin (Munich). 1996 Nov 15;91(11):681-6.
The NIDEP-study (Nosocomial Infections in Germany-Prevalence and Prevention) is the first large multicenter survey to examine the prevalence of nosocomial infections (NI) in Germany. This part of the NIDEP-study describes the frequency and quality of the microbiological diagnosis, antimicrobial chemoprophylaxis and therapy in representative German hospitals.
Prevalence of nosocomial infections in 14 966 patients of 72 randomly selected representative German hospitals was determined. Frequency, nature and results of the microbiological diagnosis, antimicrobial chemoprophylaxis and therapy were recorded simultaneously.
The total prevalence rate of nosocomial infections was 3.5%. The most common infections were urinary tract infections (42.1%), lower respiratory tract infections (20.6%), postoperative wound infections (15.8%), and septicemia (8.3%). Microbiological evaluation was done in 56.5% of the patients with infections. Only five of the 49 hospitals with less than 400 beds and only nine of the 23 hospitals with more than 400 beds had their own microbiological department. Antimicrobial chemotherapy was administered in 17.7% of the patients. In 35.1% of the patients who were treated with antibiotics, no clinical diagnosis of infection was made, criteria for nosocomial infections were not fulfilled or microbiological evaluation was not established. Antimicrobial chemoprophylaxis was done in one third of the patients. Prophylaxis was missed in 20.6% of patients with colorectal operations, 60.1% of appendectomies, 48% of vaginal hysterectomies, and 35.5% of total hip replacements. On the other hand antimicrobial chemoprophylaxis was frequently administered in clean procedures without increased risk of postoperative wound infections.
Insufficient microbiological evaluation, inadequate perioperative antimicrobial chemoprophylaxis and administration of chemotherapy without documented infection were detected in representative German hospitals.
NIDEP研究（德国医院感染——患病率与预防）是德国首次开展的一项大型多中心调查，旨在研究医院感染（NI）的患病率。NIDEP研究的这一部分描述了德国代表性医院微生物诊断、抗菌化学预防和治疗的频率及质量。
确定了72家随机选取的德国代表性医院中14966例患者的医院感染患病率。同时记录微生物诊断、抗菌化学预防和治疗的频率、性质及结果。
医院感染的总患病率为3.5%。最常见的感染为尿路感染（42.1%）、下呼吸道感染（20.6%）、术后伤口感染（15.8%）和败血症（8.3%）。56.5%的感染患者进行了微生物评估。49家床位少于400张的医院中只有5家，23家床位多于400张的医院中只有9家设有自己的微生物科。17.7%的患者接受了抗菌化疗。在接受抗生素治疗的患者中，35.1%未作出感染的临床诊断，未满足医院感染的标准或未进行微生物评估。三分之一的患者进行了抗菌化学预防。结直肠手术患者中有20.6%、阑尾切除术患者中有60.1%、阴道子宫切除术患者中有48%、全髋关节置换术患者中有35.5%未进行预防。另一方面，在清洁手术中经常进行抗菌化学预防，但术后伤口感染风险并未增加。
在德国代表性医院中发现微生物评估不足、围手术期抗菌化学预防不充分以及在无感染记录的情况下进行化疗。
