ICU患者深部真菌感染的调查与控制  

Investigation of nosocomial deep fungal infections in ICU patients and control measures

作　　者：孔庆玲[1] 马先宾[1] 汪秀芹[1] 李霞[1] 范晴[1] 

机构地区：[1]日照市人民医院医院感染控制办公室,山东日照276826

出　　处：《中华医院感染学杂志》2014年第15期3717-3719,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目[ZR2010HL053]

摘　　要：目的探讨重症监护病房(ICU)医院深部真菌感染的临床现状及有效降低感染的综合防治措施,为医院预防控制感染提供科学依据。方法调查2010-2012年ICU 2 869例危重患者临床资料,将2011年感染的72例患者分为观察组(budnle管理组)与对照组(常规管理组),进行回顾性目标性调查,追踪统计分析真菌对抗真菌药物敏感性,数据采用SPSS13.0进行分析。结果调查3年入住ICU治疗的危重患者2 869例,发生医院感染共416例感染率14.50%;3年分别为16.04%、16.08%、12.48%;发生深部真菌感染共184例,感染率6.41%,3年真菌感染率分别为8.90%、8.77%、3.28%,广谱抗菌药物应用时间>4d、使用糖皮质激素、各种侵入性操作等均是ICU患者发生深部真菌感染的独立危险因素。结论在ICU医院深部真菌感染的防治中,bundle管理理念的应用,是科学有效的综合防治措施及最佳手段,可以明显降低感染风险,提高治愈率,减少并发症的发生。OBJECTIVE To investigate the clinical status of nosocomial deep fungal infections in intensive care unit （ICU） and the effective strategy for reducing the infections so as to provide the scientific reference for nosocmial infection control. METHODS One hundred and eighty-four ICU patients with nosocomial deep fungal infections from 2010 to 2012 were included in the retrospective targeted study. Seventy-two patients in 2011 were divided into the observation group （bundle management group） and the control group （routine management group）, and the paired observation was carried out between these two groups. The antifungal drug sensitivity of fungi was traced and analyzed with SPSS 13.0. RESULTS Totally 2869 critically ill patients in ICU from 2010 to 2012 were surveyed, The nosocomial infections occurred in 416 cases, with the infection rate of 14. 5%, and the infection rates of the three years were 16.04%, 16.08%, and 12. 48%, respectively; the deep fungal infections occurred in 184 cases, with the infection rate of 6.41%. The fungal infection rate was 8.90%, 8.77% and 3.28% in the respective year. The independent risk factors of nosocomial deep fungal infections in ICU were the duration of broad-spectrum antibiotics application （4 days or longer）, the use of glucocorticoid, and various kinds of invasive procedures. CONCLUSION The application of bundle management is a scientific and effective method for comprehensive treatment and prevention and a optimal method for nosocomial deep fungal infections in ICU, which can lower the infection rate and the rate of complications and increase the cure rate.

关 键 词：深部真菌感染 重症监护病房 bundle管理 危险因素 

分 类 号：R379[医药卫生—病原生物学]