ICU医院感染监测结果与危险因素分析

Monitoring of nosocomial infections in ICU and risk factors

目的调查分析ICU医院感染率、病原菌检出分布及危险因素,为预防控制ICU医院感染提供参考。方法对2012年1-6月ICU患者进行目标性监测,将住院>48h的患者作为研究对象,应用logistic回归分析ICU医院感染危险因素。结果共收集病例199例,感染79例、150例次,感染率为39.7%、例次感染率为75.4%;送检标本主要为痰标本,鲍氏不动杆菌检出率最高,耐亚胺培南鲍氏不动杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌、产ESBLs肺炎克雷伯菌耐药率分别为94.2%、76.9%、73.9%和100.0%;单因素分析显示,住ICU天数、使用免疫抑制剂、抗菌药物、留置引流管、使用呼吸机、APACHEⅡ评分均与ICU医院感染有关(P<0.05),logistic回归分析显示,住ICU天数(P<0.01,OR=3.457)、抗菌药物使用(P=0.005,OR=1.756)是ICU医院感染的独立危险因素。结论进一步加强ICU医院感染管理与控制,严格掌握抗菌药物使用指征,尽量缩短ICU住院时间,能有效降低感染发生率。

OBJECTIVE To investigate and analyze the incidence of nosocomial infections in ICU, distribution of pathogens,and risk factors so as to provide guidance for prevention and control of nosocomial infections in ICU. METHODS The targeted surveillance was performed for the ICU patients enrolled from Jan to Jun 2012, the patients whose hospital stay were more than 48 h were selected as objects of study, then the logistic regression analysis was performed to determine the risk factors of nosocomial infections in ICU. RESULTS Of totally 199 cases of patients, the infections occurred in 79 （ 150 case-times ） cases with the infection rate of 39.7% and the case-time infection rate of 75. 4%. The specimens mainly consisted of sputum specimens, the detection rate of Acinetobacter baumannii was the highest. The results of drug susceptibility testing, indicated that the drug resistance rates of A. baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and ESBLs-producing Klebsiella pneumoniae were 94.2%, 76.9%, 73.9%, and 100.0% ,respectively; the univariate factor analysis showed that the length of ICU stay, use of immunosuppressor, indwelling drainage tube, use of breathing machine,APACHE II graded were related to the nosocomial infections in ICU （P〈0.05）, the logistic egression analysis indicated that the length of stay （P〈0.01,OR=3. 457） and use of antibiotics （P=0. 005 ,OR= 1. 756） were the independent risk factor of nosocomial infections in ICU. CONCLUSION It is necessary to strengthen the management and control of nosocomial infections in ICU, strictly master the indications of antibiotics use and shorten the length of stay so as to reduce the incidence of infections.