Epidemiology of blood stream infections at a level-1 trauma care center of India.
Epidemiology of blood stream infections at a level-1 trauma care center of India.
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DOI：
10.4103/0974-2727.129086
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发表时间：
2014-01
影响因子：
1.1
通讯作者：
Misra MC
中科院分区：
文献类型：
--
作者：
Mathur P;Varghese P;Tak V;Gunjiyal J;Lalwani S;Kumar S;Misra MC
血流感染（BSI）是医院中威胁生命的主要感染之一。他们负责延长住院时间，高昂的医疗费用和显著的死亡率。不同医院的BSI流行病学不同，需要分析当地趋势。很少有关于创伤患者的研究，这些患者由于存在多种侵入性器械而易受影响。2011年4月至2012年3月，在1级创伤中心对所有BSI进行了前瞻性监测。所有入住不同创伤重症监护室（ICU）的患者均由主治医生每日监测，以了解随后发生的院内BSI。当患者出现以下一种或多种体征/症状时，即发热、体温过低、寒战或低血压，并且至少一个或多个血培养样本显示致病菌生长，则确定为BSI发作。根据疾病预防控制中心的定义，BSI进一步分为原发性和继发性BSI。对所有发生院内BSI的患者进行随访，直至其最终结局。在240例患者中共观察到296次院内BSI。在155例（52%）发作中确定了BSI的来源。呼吸机相关性肺炎是继发性BSI的最常见来源。最常见的微生物是不动杆菌属（21.5%）。念珠菌属占所有血流微生物的12%。在革兰阴性和阳性病原体中观察到较高的抗生素耐药性流行率。创伤患者的BSI患病率较高。由于继发性菌血症更为常见，因此预防个体感染的针对性方法将有助于减轻BSI的负担。
Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices. A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome. A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens. Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.