西北某三甲医院连续10年综合ICU医院感染目标性监测  

Targeted monitoring on healthcare-associated infection in the general intensive care unit of a tertiary first-class hospital in northwest China for 10 consecutive years

作　　者：王惠[1] 张丹梅[1] 张志远[1] 赵永珍[1] 马刚[1] 杨宝忠[1] 寇华炜[1] 杨晓军[2] WANG Hui;ZHANG Dan-mei;ZHANG Zhi-yuan;ZHAO Yong-zhen;MA Gang;YANG Bao-zhong;KOU Hua-wei;YANG Xiao-jun(Department of Healthcare-associa-ted Infection Management,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院院内感染科,宁夏银川750004 [2]宁夏医科大学总医院重症医学科,宁夏银川750004

出　　处：《中国感染控制杂志》2023年第7期802-808,共7页Chinese Journal of Infection Control

摘　　要：目的 分析综合ICU连续10年医院感染相关特点及流行病学特征,为医院感染防控管理提供科学依据。方法 采用前瞻性目标性监测方法,分析某三甲医院2013年1月—2022年12月综合ICU医院感染目标性监测资料。结果 共监测患者15 189例,医院感染发病率为4.27%,例次发病率为4.73%。连续10年综合ICU医院感染发病率和例次发病率总体上处于下降趋势并趋于平稳,波动范围分别在2.73%~5.55%和2.83%~6.48%,且差异均有统计学意义(均P<0.05)。医院感染部位以呼吸系统(71.34%)、血液系统(14.46%)和泌尿系统(11.96%)为主;发生器械相关感染543例,占比为75.52%。导尿管相关尿路感染(CAUTI)、血管导管相关血流感染(CRBSI)、呼吸机相关肺炎(VAP)发病率分别为1.198‰、0.603‰和9.266‰。连续10年综合ICU器械相关感染总发病率为3.531‰;2014年最高,为5.572‰;2022年最低,为2.226‰。649例医院感染患者共检出病原菌622株,以革兰阴性菌为主(77.82%),其中检出鲍曼不动杆菌居多(48.39%);共检出多重耐药菌365株,占比58.68%,其中以耐碳青霉烯类鲍曼不动杆菌居多(80.27%)。结论 该院连续10年综合ICU医院感染相关的感染率处于较低水平,但器械相关感染和多重耐药菌管理仍是综合ICU医院感染防控管理的重点。Objective To analyze relevant characteristics and epidemiological features of healthcare-associated infection(HAI)in the general intensive care unit(GICU)for 10 consecutive years,and provide scientific basis for HAI prevention and control management.Methods The targeted monitoring data of HAI in GICU of a tertiary first-class hospital from January 2013 to December 2022 were analyzed with prospectively targeted monitoring me-thod.Results A total of 15189 patients were monitored.Incidence and case incidence of HAI were 4.27%and 4.73%,respectively.The incidence and case incidence of HAI in GICU for 10 consecutive years were in a downward trend and tended to be stable,with fluctuation ranges of 2.73%-5.55%and 2.83%-6.48%,respectively.The diffe-rences were both statistically significant(both P<0.05).The main infection sites were the respiratory system(71.34%),the blood system(14.46%)and the urinary system(11.96%).543 cases of device-related infection occurred,accounting for 75.52%.The incidences of catheter-associated urinary tract infection(CAUTI),catheter-related blood stream infection(CRBSI),and ventilator-associated pneumonia(VAP)were 1.198‰,0.603‰and 9.266‰,respectively.The total incidence of device-related infection in GICU for 10 consecutive years was 3.531‰,with the highest in 2014(5.572‰)and lowest in 2022(2.226‰).A total of 622 strains of pathogenic bacteria were isolated from 649 HAI patients,predominantly Gram-negative bacteria(77.82%),with Acinetobacter baumannii being the most commonly detected species(48.39%).A total of 365 multidrug-resistant organism strains were isolated,accounting for 58.68%,with carbapenem-resistant Acinetobacter baumannii(80.27%)being the most prevalent.Conclusion The incidence of HAI in the GICU of the hospital remains at a relatively low level for 10 consecutive years,but the management of device-related infections and multidrug-resistant organism remains the focus for the prevention and control of HAI in GICU.

关 键 词：医院感染 目标性监测 器械相关感染 多重耐药菌管理 ICU 

分 类 号：R181.32[医药卫生—流行病学]