NOSOCOMIAL BLOOD-STREAM INFECTIONS - SECULAR TRENDS IN RATES, MORTALITY, AND CONTRIBUTION TO TOTAL HOSPITAL DEATHS
NOSOCOMIAL BLOOD-STREAM INFECTIONS - SECULAR TRENDS IN RATES, MORTALITY, AND CONTRIBUTION TO TOTAL HOSPITAL DEATHS
复制标题
DOI：
10.1001/archinte.155.11.1177
复制
发表时间：
1995-06-12
影响因子：
--
通讯作者：
WENZEL, RP
中科院分区：
文献类型：
--
作者：
PITTET, D;WENZEL, RP
背景资料：在美国，医院内血流感染的发生率为每1000名住院患者1.3至14.5例，据信每年直接导致62500例死亡。对这些感染的发生率和所有医院死亡人数占死亡人数的比例的衡量，提供了对这些感染影响的估计。这项研究的目的是在一个单一的机构，医院内血流感染的长期趋势的特点，并估计人口归因的死亡风险的患者经历infection.Methods：一项为期12年的回顾性研究，前瞻性收集的数据，从医院范围内的医院感染监测系统在900张病床的三级医疗机构。所有患者（N=260 834）在1980年和1992年之间入住该机构被纳入本研究。计算了10组主要病原体的血流感染率，并使用简单线性回归分析了趋势。在医院的死亡率从病人谁没有或没有开发医院内血流感染compared.Results：在1980年和1999年之间，共有3077例患者开发3464次医院内血流感染。在12年的研究期间，粗感染率从6.7/1000次出院线性增加至18.4/1000次出院（0.83至1.72次发作/1000患者-天）（r= 0.87）。感染率的增加是由于革兰氏阳性球菌（r= 0.96）和酵母菌（r= 0.95）引起的，基本上分别由凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌和念珠菌引起的感染解释。虽然医院内血流感染患者的粗死亡率从1981年的51%下降到1992年的29%，但感染患者的院内人群归因死亡率从1981年的每1000例出院患者中3.55例死亡增加到1992年的每1000例出院患者中6.22例死亡（r= 0.67）。血液感染患者死亡的病因分数或死亡比例从1981年的11.4%增加到1992年的20.4%（r= 0.59）。结论：在过去的十年中，医院内血液感染患者的发病率、病因分数和人群归因的死亡风险逐渐增加。
Background: Nosocomial bloodstream infections occur at a rate of 1.3 to 14.5 per 1000 hospital admissions and are believed to lead directly to 62 500 deaths per year in the United States. Measures of the incidence and the proportion of all hospital deaths related to deaths from these infections provide estimates of their impact. The objectives of the study were to characterize the secular trends in nosocomial bloodstream infection at a single institution and to estimate the population-attributable risk for death among patients experiencing the infection.Methods: A 12-year retrospective study using prospectively collected data from a hospital-wide surveillance system for nosocomial infections in a 900-bed tertiary care institution. All patients (N=260 834) admitted to the institution between 1980 and 1992 were included in the study. Bloodstream infection rates were calculated for the 10 leading groups of pathogens, and trends were analyzed using simple linear regression. In-hospital mortality rates from patients who did or did not develop nosocomial bloodstream infections were compared.Results: Between 1980 and 1999, a total of 3077 patients developed 3464 episodes of nosocomial blood stream infection. The crude infection rates increased linearly from 6.7 to 18.4 per 1000 discharges (0.83 to 1.72 episodes per 1000 patient-days) during the 12-year study period (r=.87). Increases in the infection rates were due to gram-positive cocci (r=.96) and yeasts (r=.95) and essentially explained by infections caused by coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species, respectively. Although the crude mortality in patients with nosocomial bloodstream infections decreased from 51% in 1981 to 29% in 1992, the in-hospital population-attributable mortality among infected patients increased from 3.55 deaths per 1000 discharges in 1981 to 6.22 per 1000 discharges in 1992 (r=.67). The etiologic fraction or the proportion of deaths in patients with bloodstream infection to all deaths occurring in the hospital increased from 11.4% in 1981 to 20.4% in 1992 (r=.59).Conclusions: The incidence, the etiologic fraction, and the population-attributable risk for death among patients experiencing nosocomial bloodstream infections increased progressively during the last decade.