Surveillance of nosocomial infections in a neurology intensive care unit
Surveillance of nosocomial infections in a neurology intensive care unit
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DOI：
10.1007/s004150170048
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发表时间：
2001-11-01
影响因子：
6
通讯作者：
Daschner, F
中科院分区：
文献类型：
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作者：
Dettenkofer, M;Ebner, W;Daschner, F
为了确定接受神经重症监护治疗的患者的总体和特定部位的医院感染(NI)发生率，1997年在德国弗莱堡大学医院的十张床位的神经重症监护病房(NICU)开始了一项前瞻性研究。每周两次审查病例记录和微生物学报告，并咨询病房工作人员。根据疾病控制和预防中心(CDC)的标准对NI进行定义，并按特定的感染部位进行分类。在30个月内，研究了505名患者，总计4873个病例日(平均住院时间：9.6天)。在96名患者中发现122例医院感染(74例患者1例，18例2例，4例3例感染。记录了神经科ICU医院感染的发病率为24.2/100例，发病密度为25.0/1000病人日。特定部位的发病率和发病密度为：每100名患者中有1.4例血液感染(每1000例中心线相关BSI为1.9例)，每100例患者中有11.7例肺炎(每1000例呼吸机相关肺炎中有20.4例与呼吸机相关肺炎)，每100例患者中有8.7例尿路感染(每1000例导尿管相关尿路感染(UTI))。此外，每1000个病人日记录了0.4例脑膜炎、0.8例脑室炎和1.2例其他感染(与导管相关的局部感染、腹泻)。医院内致病菌中，鲍曼不动杆菌占15%，金黄色葡萄球菌占13%，大肠杆菌占10%，中枢神经系统占7%，类杆菌属占7%，肠杆菌属占7%，克雷伯氏菌属占6.5%，肠球菌占5.9%，链球菌占5.9%，假单胞菌占4.7%。8例医院感染患者均未发现病原菌。今后，应更详细地评估NICU中的医院感染数据，以提高护理质量，并作为确定和实施最有效措施的基础，通过这些措施预防接受神经重症监护的患者发生这些感染。
To identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurological intensive care therapy, a prospective study was started in 1997 in the ten-bed neurological intensive-care unit (NICU) of the University Hospital of Freiburg, Germany. Case records and microbiology reports were reviewed twice a week, and ward staff were consulted. NI were defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Within 30 months, 505 patients with a total of 4,873 patient days were studied (mean length of stay: 9.6 days). 122 NI were identified in 96 patients (74 patients with one, 18 with two and 4 with three infections. An incidence of 24.2/100 patients and incidence density of 25.0/1,000 patient days of NI in the neurological ICU were documented. Site-specific incidence rates and incidence densities were: 1.4 bloodstream infections per 100 patients (1.9 central line-associated BSIs per 1,000 central line-days), 11.7 pneumonias per 100 patients (20.4 ventilator-associated pneumonias per 1,000 ventilator-days), 8.7 urinary tract infections per 100 patients (10.0 urinary catheter-associated urinary track infections (UTIs) per 1,000 urinary catheter-days). Additionally, 0.4 cases of meningitis, 0.8 ventriculitis, and 1.2 other infections (catheter-related local infection, diarrhea) were documented per 1,000 patient days. 15 % of nosocomial pathogens were A. baumannii (due to a outbreak of an nosocomial pneumonia with A. baumannii),13 % S. aureus, 10 % E. coli,7 % CNS, 7 % Bacteroides spp., 7 % Enterobacter spp., 6, 5 % Klebsiella spp., 5.9 % enterococci, 5.9 streptococci, and 4.7 Pseudomonas spp. In eight cases of NI no pathogen could be isolated. in future, data on NI in NICUs should be assessed in greater detail, both to improve the quality of care and serve as a basis for identification and implementation of the most effective measures by which to prevent these infections in patients receiving intensive neurological care.