Wang F D, Chen Y Y, Liu C Y
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Oct;61(10):589-95.
The intensive care unit (ICU) is one of the most common locations in the hospital for the development of nosocomial respiratory tract infections (RTIs). The purpose of this study was to better understand and compare the rate of nosocomial RTIs, their distribution and the frequency of infective organisms in three different adult surgical ICUs at a medical center in Taiwan.
This retrospective study covered the period from 1991 to 1996, and targeted patients who had acquired nosocomial RTIs more than 72 hours after admission to the surgical, cardiovascular surgical, or neurosurgical ICU. Infection control nurses made routine weekly rounds to the units and conducted comprehensive patient-based surveys. Data collected were subjected to descriptive and deductive statistical analyses.
A total of 277 episodes of nosocomial RTIs were encountered (3.8 episodes per 1,000 patient-days of hospitalization). Neurosurgical ICU patients had the highest infection rate (4.8%) (p < 0.01). The median length of hospital stay of patients acquiring nosocomial RTIs was 61 days; the infection occurred 19 days (median) after admission to the ICU and the length of postinfection stay was 38 days (median). Pneumonia accounted for 91.3% of these infections. The overall mortality rate was 42.6%, with the surgical ICU having the highest mortality rate (61.5%), which was significantly higher compared with the other two ICUs studied. The majority of patients with nosocomial RTIs had medical catheters or devices in place. A total of 297 isolates were cultured from 277 infected patients. Pseudomonas aeruginosa was the predominant organism isolated (29.6%), followed by Staphylococcus aureus (26.6%), of which 88.2% were methicillin-resistant S aureus (MRSA).
The rate of nosocomial RTIs was significantly higher in neurosurgical ICU patients; the majority of infected patients had medical catheters or devices in place. S aureus played an increasingly important role as a nosocomial pathogen; hence, control of MRSA should be the focus of infection control policies.
重症监护病房（ICU）是医院内医院获得性呼吸道感染（RTIs）最常见的发生地点之一。本研究的目的是更好地了解和比较台湾某医疗中心三个不同的成人外科ICU中医院获得性RTIs的发生率、分布情况以及感染病原体的频率。
这项回顾性研究涵盖了1991年至1996年期间，目标是入住外科、心血管外科或神经外科ICU超过72小时后发生医院获得性RTIs的患者。感染控制护士每周对各科室进行常规查房，并基于患者进行全面调查。收集的数据进行描述性和演绎性统计分析。
共遇到277例医院获得性RTIs（每1000住院患者日3.8例）。神经外科ICU患者的感染率最高（4.8%）（p<0.01）。发生医院获得性RTIs的患者住院中位时间为61天；感染发生在入住ICU后19天（中位时间），感染后住院时间为38天（中位时间）。肺炎占这些感染的91.3%。总体死亡率为42.6%，外科ICU的死亡率最高（61.5%），与其他两个研究的ICU相比显著更高。大多数医院获得性RTIs患者都有医用导管或装置。从277例感染患者中共培养出297株分离菌。铜绿假单胞菌是分离出的主要病原体（29.6%），其次是金黄色葡萄球菌（26.6%），其中88.2%为耐甲氧西林金黄色葡萄球菌（MRSA）。
神经外科ICU患者医院获得性RTIs的发生率显著更高；大多数感染患者都有医用导管或装置。金黄色葡萄球菌作为医院病原体发挥着越来越重要的作用；因此，控制MRSA应成为感染控制政策的重点。
