三级教学医院综合ICU导管相关性感染的目标性监测  

Targeted surveillance of catheter-related infections in integrated ICUs of a tertiary teaching hospital

作　　者：陶秀彬[1] 阮晶晶[1] 李燕[1] 钱丽华[1] 蔡东珍[1] 吴群[1] 吴敬医[2] 

机构地区：[1]皖南医学院弋矶山医院感染管理科,安徽芜湖241000 [2]皖南医学院弋矶山医院ICU,安徽芜湖241000

出　　处：《中华医院感染学杂志》2015年第1期119-121,共3页Chinese Journal of Nosocomiology

基　　金：安徽省自然科学研究重大基金资助项目(KJ2014ZD32)

摘　　要：目的了解综合ICU患者导管相关性感染的现状及特点,为制定预防控制方案提供依据。方法根据目标性监测要求,对2012年1-12月ICU患者的医院感染发病率、3种导管相关感染及常见病原菌特点进行监测,采用MINKE医院感染管理软件系统对监测资料进行汇总分析。结果 814例ICU住院时间>48h的患者,发生医院感染74例次、例次感染率为9.09%,例次千日感染率为11.50‰,调整后日例次感染率为3.87‰;3种导管相关性感染率以呼吸机相关性感染居首位,千日感染率为22.72‰,留置尿管和中心静脉置管相关性感染次之,分别为1.94‰和1.47‰;共分离病原菌103株,其中革兰阴性菌79株占76.70%,革兰阳性菌11株占10.68%,真菌13株占12.62%;ICU医院感染检出的主要病原菌耐药现象严重,其中金黄色葡萄球菌对万古霉素和利奈唑胺保持全敏感,真菌对伏立康唑、伊曲康唑和两性霉素B均敏感,肠杆菌科细菌对亚胺培南、美罗培南、头孢替坦、阿米卡星等抗菌药物保持较高的敏感性。结论 3种导管的使用率和感染率与国内统计数据相仿,但是呼吸机相关性肺炎(VAP)的发生率远高于美国国家医疗安全网络(NHSN)统计数据,需重点加强预防VAP干预措施的制定。OBJECTIVE To investigate the current status and characteristics of catheter-related infections in patients of integrated ICUs so as to provide guidance for prevention and control of the infections.METHODS The targeted surveillance was conducted for the incidence of nosocomial infections,three types of catheters-related infections, and characteristics of common pathogens in the ICU patients who were treated from Jan 2012 to Dec 2012,and the surveillance data were summarized and analyzed by using MINKE nosocomial infections control software. RESULTS The nosocomial infections occurred in 74 case-times of 814 patients with the length of ICU stay more than 48 hours with the case-time infection rate of 9.09%;the case-time thousand day infection rate was 11.50‰,and the adjus-ted daily case-time infection rate was 3.87‰.Among the three types of catheters-related infections,the ventilator-associ-ated infections ranked the first place,with the thousand day infection rate of 22.72‰,followed by the urinary catheter-related infections （1.94‰）and the central venous catheter-related infections （1.47‰）.A total of 103 strains of patho-gens have been isolated,including 79 （76.70%）strains of gram-negative bacteria,11 （10.68%）strains of gram-positive bacteria,and 1 3 （1 2 .6 2%）strains of fungi.The maj or species of pathogens isolated from the ICU patients with nosoco-mial infections were highly drug-resistant;all the Staphylococcus aureus strains maintained susceptible to vancomycin and linezolid;the fungi were susceptible to voriconazole,itraconazole,and amphotericin B;the Enterobacteriaceae species maintained high susceptibility to imipenem,meropenem,cefotetan,and amikacin.CONCLUSION The utilization rates of the three types of catheters and the infection rate are similar to the domestic statistics,however,the incidence of ventilator-associated pneumonia （VAP）is significantly higher than the statistics of the National Health Safety Network （NHSN）,thus,it is necessary to focus on the prevention

关 键 词：重症监护病房 导管相关性感染 监测 

分 类 号：R181.32[医药卫生—流行病学]