重症监护病房医院感染特点及危险因素分析

Characteristics and Risk Factors of Nosocomial Infection in Intensive Care Unit

目的了解重症监护病房(ICU)住院患者医院感染特点、病原菌分布及耐药性变化特征,分析危险因素,为制定对策提供科学依据。方法采用目标性监测方法 ,对2008年9月1日-2009年12月31日365例入住ICU的患者进行前瞻性监测,并对相关危险因素进行调查和分析,所有数据应用SPSS13.0软件处理。结果 ICU医院感染发病率11.23%;感染部位前3位为呼吸道、手术切口和皮肤软组织、呼吸道感染最高,占50.00%;其中呼吸机相关性肺炎占呼吸道感染的56.67%;医院感染的病原菌以革兰阴性杆菌为主;革兰阴性杆菌对亚胺培南、美罗培南和哌拉西林/他唑巴坦、阿米卡星保持有高的敏感性,而对其他抗菌药物则有不同程度的耐药;单因素分析结果显示,急诊手术、气管切开、深静脉导管、住ICU、机械通气时间和入ICU的病情是ICU感染的相关因素,差异有统计学意义(P<0.05);非条件Logistic回归多因素分析结果显示,机械通气时间和住ICU时间为医院感染的独立危险因素。结论 ICU医院感染的发病率高于普通病房,ICU医院感染部位以呼吸道为主,应积极采取多项措施降低呼吸机相关性肺炎的发生率,应掌握ICU病原菌变化规律,为合理使用抗菌药物作指导。

OBJECTIVE To investigate the characteristics of nosocomial infections in Intensive Care Unit （ICU）, understand pathogens distributing and the transformation characteristics of drug resistance, analyzes the risk factors, in order to provide a scientific basis for the development. METHODS Using the method of target monitoring,a total of 365 patients who were in the ICU from Sep 1, 2008 to Dec 31, 2009 are in prospective surveillance. And risk facters were investigated and analyzed. All date are processed by the software of SPSS 13.0. RESULTS The nosocomial infection rate in ICU was 11. 23%. The first three parts of infection sites were respiratory tract, surgical incisions and skin soft tissue. Respiratory tract was the highest, accounting for 50.00%. Ventilator-associated pneumonia accounted for 56.67% of the infection rate of respiratory tract among them. The main pathogen was Gram-negative bacilli. Gram-negative bacilli was highly sensitive to imipenem, meropenem, amikacin and piperacillin/tazobactam, while it had drug resistance of varying degrees for other antibiotics; Chi-square test of related factors on nosocomial infections showed that emergency surgery, tracheotomy, deep venous catheter, long hospitalization, mechanical ventilation time and the condition when into the ICU were the associated factors of infection in the ICU. Non-conditional logistic regression multivariate analysis showed that mechanical ventilation time and long hospitalization were the independent risk factors of nosoeomial infections. CONCLUSIONS The incidence rate of nosocomial infections in the ICU is higher than that in the common ward. The respiratory tract is still the main site of nosocomial infections in the ICU; various measures should be actively adopted to reduce the morbidity of ventilator-associated pneumonia. Variations of pathogens should be in control for the rational use of antibiotics in ICU as a guide in order to reduce the production of bacterial drug resistance.