患者在ICU期间血流感染的发生率及对患者结局的影响

Incidence of Bloodstream Infection in the Intensive Care Unit and Its Impact on the Prognosis of Patients

目的调查患者在ICU期间血流感染的发生率并评估其对患者结局的影响。方法对所有进入ICU并且在ICU期间送检血培养的患者进行回顾性分析,记录的数据包括患者人口统计数据、可能的感染源、既往抗生素使用情况和ICU内的处理过程。使用急性生理学与慢性健康状况评分系统Ⅱ对患者病情的严重程度进行评估。结果在被调查的567名患者中,42%的患者使用过抗生素,64%的患者因急症直接进入ICU,10.76%的患者来自病房,19.05%的患者来自其他类ICU,19.05%的患者转自其他医院。血培养阳性患者占10.6%,其病死率显著高于血培养阴性患者(45%vs 13.6%,P=0.000)。通过Logistic回归分析发现,只有抗生素的使用与血流感染患者高病死率具有统计学意义上的相关性(P=0.002)。结论在疑似感染的ICU患者中只有少数患者血培养是阳性的,然而这些血培养阳性患者的预后是很差的,特别是正在使用抗生素而血培养为阳性的患者。

Objective To investigate the incidence of bloodstream infection for patients suspected to have infection at the time of ICU admission and to assess its impact on the outcome. Methods Retrospective cohort study from all the admissions in ICU, in whom blood cultures sent at the time of admission were analyzed. Data regarding patient demographics, probable source of infection, previousantibiotic use and ICU course were recorded. Severity of illness on admission was assessed by acute physiology and chronic health evalua- tion Ⅱ score （APACHE Ⅱ ）. Results Of 567 patients, 42% patients were on antibiotics. Sixty - four percent of the patients were direct ICU admission from casualty, 10.76% were from wards and 6.17% from other ICUs, and 19.05% were transfers from other hospitals. Blood cultures were positive in 10.6% patients. Mortality was significantly higher in patients with positive blood cultures （45% vs 13.6% ,P = 0. 000）. On Logistic regression analysis, only previous antibiotic use was statistically associated with higher mortality in pa- tients with bacteremia （P = 0. 002）. Conclusion Blood cultures may be positive in only minority of the patients with suspected infection admitted to ICU. Nevertheless, the prognosis of those patients with positive blood culture is worse, especially if culture is positive in spite of the patient being on antibiotics.