2020—2022年北京市某三级医院重症监护病房器械相关医院感染动态监测结果分析

Analysis of the dynamic surveillance results of device-associated nosocomial infection in ICU of a tertiary hospital in Beijing from 2020 to 2022

目的 通过动态目标性监测分析重症监护病房(以下简称“ICU”)器械相关医院感染特征,为科学制定预防和控制器械相关医院感染策略提供依据。方法 采用R 4.1.3软件,通过描述性分析、Mantel-Haenszel分层分析、CochranArmitage趋势检验等方法对北京市某三级医院目标性监测中2020—2022年ICU住院患者器械相关医院感染情况进行分析,检验水准为α=0.05。结果 2020—2022年该医院共开展目标性监测2 749例,其中发生器械相关感染66例(2.40%)。连续3年呼吸机相关肺炎(ventilator-associated pneumonia,VAP)发病率分别为2.28‰、3.65‰和1.12‰,血管导管相关血流感染(central line associated bloodstream infection,CLABSI)发病率分别为5.38‰、9.52‰和8.80‰,导尿管相关尿路感染(catheter associated urinary tract infection,CAUTI)发病率分别为0.72‰、1.65‰和1.43‰,不同年份的VAP、CLBSI和CAUTI发病率差异均无统计学意义(P均>0.05)。2020—2022年呼吸机使用率分别为25.00%、32.65%和30.48%,不同年份呼吸机使用率差异有统计学意义(χ^(2)=13.406,P=0.001);连续3年导尿管使用率分别为91.41%、91.61%和91.56%,不同年份导尿管使用率差异无统计学意义(χ^(2)=0.026,P=0.987);连续3年中心静脉导管使用率分别为40.62%、47.39%和43.05%,不同年份中心静脉导管使用率差异有统计学意义(χ^(2)=8.498,P=0.014)。不同性别、住院天数、住ICU小时数以及是否使用呼吸机、中心静脉导管对器械相关医院感染发生率之间的差异均有统计学意义(P均<0.05)。共检出病原菌68株,以革兰阴性菌为主(63.24%),连续3年病原菌耐药率依次为47.37%、63.64%和62.96%,Cochran-Armitage趋势检验(Z=0.997,P=0.319)。结论 2020—2022年该院ICU器械相关医院感染发生情况总体稳定。持续加强ICU器械相关医院感染目标性动态监测,尤其要关注男性、住院天数≥20 d、入ICU>96 h、使用有创呼吸机和中心静脉置管的患者,采取切实可行的措施,防控医院感染的发生。

Objective To analyze the characteristics of device-associated nosocomial infection in intensive care unit(ICU)through dynamic targeted monitoring,and to provide scientific basis for the formulation of device-associated nosocomial infection prevention and control strategy.Methods R 4.1.3 software was used to analyze the status of device-associated nosocomial infection targeted monitored in ICU patients in a tertiary hospital in Beijing from 2020 to 2022 through descriptive analysis,Mantel-Haenszel stratified analysis,Cochran-Armitage trend test and other methods.The test level was α=0.05.Results From 2020 to 2022,a total of 2 749 cases were targeted monitored in the hospital,of which 66 cases(2.4%) had device-associated infection.The incidence rates of ventilator associated pneumonia(VAP) were 2.28‰,3.65‰ and 1.12‰,respectively.The incidence rates of central line associated bloodstream infection(CLABSI) were 5.38‰,9.52‰ and 8.80‰,respectively.The incidence rates of catheter-associated urinary tract infection(CAUTI) were 0.72‰,1.65‰ and1.43‰,respectively.There was no significant difference in the incidence of VAP,CLABSI and CAUTI among different years(all P>0.05).From 2020 to 2022,the utilization rates of ventilators were 25.00%,32.65% and 30.48%,respectively,and there were significant differences in the utilization rate of ventilators among different years (χ^(2)=13.406,P=0.001).The utilization rate of catheters for the three consecutive years were 91.41%,91.61% and 91.56%,respectively.There was no significant difference in the utilization rate of catheters among these years (χ^(2)=0.026,P=0.987).The utilization rate of central venous catheters for the three consecutive years were 40.62%,47.39%and 43.05%,respectively.There were significant differences in the utilization rate of central venous catheters among different years (χ^(2)=8.498,P=0.014).There were significant differences in the incidence rate of device-related hospital infection among different genders,hospitalization days,ICU hours,and whether ventilator or central venous catheter was used(all P<0.05).A total of 68strains of pathogenic bacteria were detected,mainly Gram-negative bacteria(63.24%).The rates of drug resistance in the consecutive three years were 47.37%,63.64% and 62.96%,respectively.Cochran-Armitage trend test showed that Z=0.997,P=0.319.Conclusions The status of deviceassociated nosocomial infection in ICU in the hospital was generally stable from 2020 to 2022.It is suggested to strengthen the targeted dynamic monitoring of device-associated hospital infection in ICU,and special attention should be paid to male patients,patients with ≥20 days of hospitalization,>96hours of ICU admission and invasive ventilators and central venous catheters.Practical measures should be taken to prevent and control hospital infection.