PICU医院感染病例分析

Prevalence of nosocomial infections in PICU

目的分析2011-2012年上半年儿童重症监护病房(PICU)医院感染情况,为干预措施的制定提供参考。方法 2011年开始,采用前瞻性监测方法,开展PICU医院感染目标性监测,同时对高危因素进行干预。结果共监测1408例患儿,发生医院感染97例、112例次,感染率为6.89%、例次感染率为7.95%,日感染率为10.9‰、日例次感染率为12.11‰,调整日感染率3.87‰;感染部位以呼吸道为主,61例占54.46%,其次为胃肠道、血液、皮肤与软组织,分别占25.89%和7.14%;发生医院感染的97例患儿中,进行气管插管61例占62.89%,发生呼吸机相关性肺炎40例,发生率65.57%;进行中心静脉置管16例,占16.49%,发生相关导管相关血流感染1例,发生率6.25%,留置尿管26例,占26.8%,发生导尿管相关尿路感染4例,发生率15.38%;共分离出病原菌60株,排名前5位病原菌依次为嗜麦芽寡养单胞菌、鲍氏不动杆菌、洋葱伯克霍尔德菌、白色假丝酵母菌、肺炎克雷伯菌,分别占20.00%、16.67%、11.67%、11.67%、6.67%。结论 PICU患者是医院感染的高危人群,应制定综合干预措施,降低医院感染的发生。

OBJECTIVE To analyze the incidence of nosocomial infections in pediatric intensive care unit （PICU） in the first half of 2011 - 2012 so as to put forward intervention measures. METHODS By means of prospective survey, the targeted surveillance of nosocomial infections was performed from 2011, meanwhile the interventions were taken in response to the high risk factors. RESULTS Of totally 1408 children investigated, the nosocomial infections occurred in 97 cases （112 case-times） with the infection rate of 6.89 % and the case-time infection rate of 7.95% ,the daily infection rate was 10.9 ‰ ,the daily case-time infection rate was 12.11%0, and the adjusted daily infection rate was 3.87‰. There were 61 （54.46%） cases of respiratory tract infections, 25.89% of the cases of infections were with gastrointestinal tract infections, 7.14% were with bloodstream infections, and 4.46% were with skin and soft tissue infections. Of totally the 97 children with nosocomial infections, there were 61 （62.89%） children who underwent endotracheal intubation, and the ventilator-associated pneumonia occurred in 40 cases with the incidence rate of 65.57% there were 61 （16.49%） children who underwent central venous catheterization, and the catheter-related bloodstream infections occurred in 1 case with the incidence rate of 6.25% there were 26 children who underwent urinary catheterization, and the catheter-related urinary tract infections occurred in 4 cases with the infection rate of 15.38%. A total of 60 strains of pathogens were isolated, among which the StenOtrophomonas maltophilia aeromonas （20. 00%）, Acinetobacter baumannii （16. 67M）, Burkholderia cepacia （11.67%）, Candida albicans （11.67%）, and Klebsiella pneurnoniae （6.67M） ranked the top five species. CONCLUSION The PICU patients are the population at high risk of nosocomial infections,it is necessary to formulate comprehensive intervention measures so as to reduce the incidence of nosocomial infections.