ICU目标性监测在医院获得性真菌尿路感染的应用

Targeted surveillance of hospital-acquired fungal urinary tract infections in ICU

目的通过对ICU住院患者进行监测,掌握患者医院感染现状和相关影响因素,以便及时采取有效地控制措施。方法运用前瞻性调查方法,对2011年1-12月入住医院ICU的1198例患者作目标性监测,调查分析每月导尿管、呼吸机、血管置管等侵入性操作导致医院感染的发生,针对集中出现的医院获得性真菌尿路感染展开调查,并采取相应的预防控制措施。结果通过监测发现10月份85例患者共639d持续使用导尿管期间出现了6例真菌性泌尿系统感染,导尿管相关性尿道日真菌感染率达9.39‰,较1-9月份903例患者共5892d的持续使用尿管期间出现18例真菌性泌尿系统感染的平均水平3.05‰高,差异有统计学意义(χ2=4.64,P<0.05),发生感染与≥二联使用抗菌药物相关(P<0.05),采取预防控制措施后感染得到控制。结论 ICU是发生医院感染的高危科室,开展目标性监测具有必要性和可行性,并且对实时监控医院感染的发生和采取防控措施有实际的意义。

OBJECTIVE To monitor the hospitalized patients in intensive care unit （ICU）, grasp the current status of nosocomial infections and the related impact factors so as to take effective control measures. METHODS By means of the prospective survey, the targeted surveillance was performed for the patients who enrolled the ICU from Jan 2011 to Dec 2011. The invasive operations like the urinary catheter, ventilator, and the vascular catheter, which may result in nosocomial infections, were investigated monthly. The investigation was then conducted according to the emergence of hospital-acquired fungal urinary tract infections, and the corresponding prevention measures were adopted. RESULTS Totally 6 patients with fungal urinary tract infections were detected through the monitoring of consecutive use of catheter for 639 days in Oct, the incidence of the catheter-related urinary tract infections per day was 9. 39‰, as compared with the incidence of 3.05‰ in 18 of 903 patients with the consecutive use of urinary catheter for 5892 days, the difference was statistically significant （χ2 = 4.64,P〈0.05）, we have found in a timely manner that the infections were related to the two-drug combination use or the two-drug above （P〈0.05）, the infections were under control after taking the prevention measures. CONCLUSION The ICU is at high risk of nosocomial infections, it is necessary and feasible to carry out the targeted surveillance and is of practical significance in the real-time monitoring of nosocomial infections as well as in taking prevention measures.