Infections in a surgical intensive care unit of a university hospital in Greece
Infections in a surgical intensive care unit of a university hospital in Greece
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DOI：
10.1016/j.ijid.2008.05.1227
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发表时间：
2009-03-01
影响因子：
8.4
通讯作者：
Katsaragakis, Stilianos
中科院分区：
文献类型：
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作者：
Markogiannakis, Haridimos;Pachylaki, Nikoleta;Katsaragakis, Stilianos
目的：我们旨在评估在我们的外科重症监护病房（SICU）发生感染的患者的临床和微生物学特征。方法：这是一项前瞻性研究，研究对象为2002年至2004年间所有发生重症监护病房获得性感染的患者。结果：在683例连续SICU患者中，123例（18.0%）发生241例感染（每1000患者日感染48.3例）。患者的平均年龄为66.7 +/- 3.8岁，SICU入院时的平均APACHE II评分（急性生理和慢性健康评估）为18.2 +/- 2.4，感染开始时的平均SOFA评分（败血症相关器官衰竭评估）为8.8 +/- 2。在研究患者中，51.2%为女性。感染类型为：血流感染（36.1%）、呼吸机相关性肺炎（VAP; 25.3%， 20.3/1000呼吸机-天）、手术部位感染（18.7%）、中心静脉导管感染（10.4%，7.1/1000中心静脉导管-天）、尿路感染（9.5%，4.6/1000导尿管-天）。最常见的微生物为鲍曼不动杆菌（20.3%）、铜绿假单胞菌（15.7%）、白色念珠菌（13.2%）、粪肠球菌（10.4%）、肺炎克雷伯菌（9.2%）、屎肠球菌（7.9%）、金黄色葡萄球菌（6.7%）。发现对大多数抗生素具有高耐药性。并发症和死亡率分别为58.5%和39.0%。多因素分析确定入院时APACHE 11评分（优势比（OR） 4.63, 95%可信区间（CI） 2.69-5.26, p = 0.01）、腹膜炎（OR 1.85, 95% CI 1.03-3.25, p = 0.03）、急性胰腺炎（OR 2.27, 95% CI 1.05-3.75, p = 0.02）、既往氨基糖苷使用（OR 2.84, 95% CI 1.06-5.14, p = 0.03）和机械通气（OR 3.26, 95% CI 2.43-6.15, p = 0.01）是感染发展的危险因素。年龄（OR 1.16, 95% CI 1.01-1.33, p = 0.03）、入院时APACHE 11评分（OR 2.53, 95% CI 1.77-3.41, p = 0.02）、感染开始时SOFA评分（OR 2.88, 95% CI 1.85-4.02, p = 0.02）和VAP （OR 1.32, 95% CI 1.04-1.85, p = 0.03）与死亡率相关。结论：感染是sicu的重要问题，感染发生率高、耐多药、并发症多、死亡率高。在我们的研究中，入院时APACHE II评分、腹膜炎、急性胰腺炎、既往氨基糖苷使用和机械通气被确定为感染发展的危险因素，而年龄、入院时APACHE II评分、感染发病时SOFA评分和VAP与死亡率相关。(C) 2008年国际传染病学会。Elsevier Ltd.出版。版权所有。
Objectives: We aimed to evaluate the clinical and microbiological characteristics of the patients who developed an infection in our surgical intensive care unit (SICU).Methods: This was a prospective study of all patients who sustained an ICU-acquired infection from 2002 to 2004.Results: Among 683 consecutive SICU patients, 123 (18.0%) developed 241 infections (48.3 infections per 1000 patient-days). The mean age of patients was 66.7 +/- 3.8 years, the mean APACHE II score (acute physiology and chronic health evaluation) on SICU admission was 18.2 +/- 2.4, and the mean SOFA score (sepsis-related organ failure assessment) at the onset of infection was 8.8 +/- 2. Of the study patients, 51.2% were women. Infections were: bloodstream (36.1%), ventilator-associated pneumonia (VAP; 25.3%, 20.3/1000 ventilator-days), surgical site (18.7%), central venous catheter (10.4%, 7.1/1000 central venous catheter-days), and urinary tract infection (9.5%, 4.6/1000 urinary catheter-days). The most frequent microorganisms found were: Acinetobacter baumannii (20.3%), Pseudomonas aeruginosa (15.7%), Candida albicans (13.2%), Enterococcus faecalis (10.4%), Klebsiella pneumoniae (9.2%), Enterococcus faecium (7.9%), and Staphylococcus aureus (6.7%). High resistance to the majority of antibiotics was identified. The complication and mortality rates were 58.5% and 39.0%, respectively. Multivariate analysis identified APACHE 11 score on admission (odds ratio (OR) 4.63, 95% confidence interval (CI) 2.69-5.26, p = 0.01), peritonitis (OR 1.85, 95% CI 1.03-3.25, p = 0.03), acute pancreatitis (OR 2.27, 95% CI 1.05-3.75, p = 0.02), previous aminoglycoside use (OR 2.84, 95% CI 1.06-5.14, p = 0.03), and mechanical ventilation (OR 3.26, 95% CI: 2.43-6.15, p = 0.01) as risk factors for infection development. Age (OR 1.16, 95% CI 1.01-1.33, p = 0.03), APACHE 11 score on admission (OR 2.53, 95% CI 1.77-3.41, p = 0.02), SOFA score at the onset of infection (OR 2.88, 95% CI 1.85-4.02, p = 0.02), and VAP (OR 1.32, 95% CI 1.04-1.85, p = 0.03) were associated with mortality. Conclusions: Infections are an important problem in SICUs due to high incidence, multi-drug resistance, complications, and mortality rate. In our study, APACHE II score on admission, peritonitis, acute pancreatitis, previous aminoglycoside use, and mechanical ventilation were identified as risk factors for infection development, whereas age, APACHE II score on admission, SOFA score at the onset of infection, and VAP were associated with mortality. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.