Surveillance of infections acquired in intensive care: usefulness in clinical practice
Surveillance of infections acquired in intensive care: usefulness in clinical practice
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DOI：
10.1053/jhin.2002.1271
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发表时间：
2002-10-01
影响因子：
6.9
通讯作者：
Candiani, A
中科院分区：
文献类型：
--
作者：
Urli, T;Perone, G;Candiani, A
医院感染监测在美国和一些欧洲国家很常见，但在意大利很少有医院使用它。为了评估其在临床实践中的实用性，我们进行了一项为期一年的前瞻性流行病学研究，其中包括 178 名入住重症监护病房 (ICU) 超过 48 小时的患者。 ICU 住院时间中位数为 16 天。外伤和神经系统疾病占入院人数的 65%。所选人群的严重程度评分较高，需要大量侵入性手术进行诊断和治疗。最常见的感染是： 肺炎 46/1000 呼吸机天数；尿路感染 17/1000 导尿管日；中心静脉导管感染 14.5/1000 导管日，其中 1.7/1000 CVC 相关败血症；菌血症败血症 12/1000 ICU 天。最常见的病原体是金黄色葡萄球菌、铜绿假单胞菌、其他革兰氏阴性需氧菌和念珠菌属。抗生素耐药性很大，金黄色葡萄球菌中 68% 的甲氧西林耐药性，铜绿假单胞菌中 76% 的抗生素耐药性。 30名患者（8/1000 ICU天）出现严重败血症或感染性休克，3名患者死于不明原因的感染性休克（病死率10%）。没有因肺炎和菌血症性败血症死亡的病例。总体而言，ICU 获得性感染与死亡风险增加无关。 (C) 2002 年医院感染协会。
Nosocomial infection surveillance is common in the USA and in some European countries but in Italy few hospitals use it. In order to evaluate its usefulness in clinical practice we performed a one year prospective epidemiological study that included 178 patients, admitted to an intensive care unit (ICU) for more than 48 h. Median ICU stay was 16 days. Trauma and neurological diseases accounted for 65% of admissions. The selected population had high severity scores and required a large number of invasive procedures for diagnosis and therapy. The most common infections were: pneumonia 46/1000 ventilator-days; urinary tract infections 17/1000 catheter-days; central venous catheter infections 14.5/1000 catheter-days with 1.7/1000 CVC-related sepsis; bacteraemic sepsis 12/1000 ICU-days. The most frequent pathogens were Staphylococcus aureus, Pseudomonas aeruginosa, other Gram-negative aerobes and Candida spp. Antimicrobial resistance was substantial, with 68% methicillin-resistance in S. aureus and 76% of P. aeruginosa displaying antibiotic resistance. Severe sepsis or septic shock occured in 30 patients (8/1000 ICU-days), and three patients died from septic shock of unknown origin (10% case fatality rate). There were no case fatalities for pneumonia and bacteraemic sepsis. Overall, ICU-acquired infections were not associated with an increased risk of death. (C) 2002 The Hospital Infection Society.