多中心ICU获得性下呼吸道感染监测报告

Multicenter monitoring report on intensive care unit-acquired lower respiratory tract infection

目的了解重症监护室(ICU)获得性下呼吸道感染情况及病原体分布特点,为采取预防控制措施和科学诊治患者提供依据。方法采用回顾性调查,收集某省32所医院ICU2013年全年医院感染目标性监测资料。结果 32所医院,ICU获得性下呼吸道感染发病率为5.79%,呼吸机使用率为31.25%,呼吸机相关性肺炎(VAP)发病率为26.93‰;呼吸机使用率与VAP发病率相关性分析(r=0.160,P=0.380),差异无统计学意义,两者无直线相关关系。共检出阳性菌株1 593株,其中以革兰阴性菌居多(1 207株,占75.77%),其次为革兰阳性菌(290株,占18.21%),真菌(94株,占5.90%),肺炎支原体和其他病原体(各1株,占0.12%)。下呼吸道感染病原体居前5位的分别是鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌,分别占25.49%、15.26%、14.63%、13.37%和5.09%。结论 ICU目标性监测有助于了解医院获得性下呼吸道感染情况,各医院应针对本单位的监测结果 ,积极查找原因,并加强ICU医院感染控制标准规范的学习,开展目标性监测,提高ICU医务人员对VAP感染预防措施的认知程度与措施执行力。

Objective To understand the status of intensive care unit-acquired lower respiratory tract infection （ICU- LRTI）, and the distribution characteristics of pathogens, so as to provide the basis for taking preventive and control meas- ures, and scientific diagnosis and treatment for patients. Methods Targeted monitoring data on healthcare-associated infec- tion （HAD in ICUs of 32 hospitals in a province in 2013 were investigated retrospectively. Results The incidence of ICU- LRTI was 5.79%, ventilator usage rate was 31.25%, incidence of ventilator-associated pneumonia（VAP ） was 26. 93%0 There was no linear correlation between ventilator usage rate and incidence of VAP （r = 0. 160, P = 0. 380）. A total of 1 593 pathogens causing LRTI were detected, the major were gram-negative bacteria （75.77 %, n = 1 207）, followed by gram- positive bacteria（18. 21% ,n = 290） ,fungi（5.90%, n = 94） ,Mycoplasma pneumonia and other pathogens（0. 12 %, n = 1 for each）. The top five detected pathogens causing LRTI were Acinetobacter baumannii, Pseudomonas aeruginosa, Staph- ylococcus aureus, Klebsiella pneurnoniae and Escherichia coli, accounting for 25.49%, 15.26%, 14. 63%, 13.37% and 5.09% respectively. Conclusion Targeted monitoring on ICU is helpful for realizing healthcare-associated LRTI, each hospital should conduct targeted monitor to find out the causes of HAI, as well as improve the awareness of VAP among ICU health care workers.