Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length...Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,which are closely related to ICU-acquired weakness(ICUAW).It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors.ICU-AW is the most common neuromuscular injury in the ICU,which affects clinical progression and outcomes of patients.This manuscript helps to improve the early recognition of ICU-AW,thereby reducing mortality and improving prognosis.展开更多
Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to dev...Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals,thereby mitigating the incidence of nosocomial LRTIs in ICU patients.Methods:A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City.Patients with LRTIs constituted the case group,while those without LRTIs constituted the control group,where a 1:1 matching principle was adhered to.A single-factor chi-square(χ2)test was employed to analyze the risk factors,with independent risk factors being explored using a multivariate logistic regression analysis.Results:A total of 169 strains of pathogenic bacteria were isolated,comprising 66.28%gram-negative bacteria,17.75%gram-positive bacteria,and 15.97%fungi.The most prevalent pathogens included Acinetobacter baumannii(43.20%),Candida albicans(10.65%),and Pseudomonas aeruginosa(8.88%).Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs,81.7%were carbapenem-resistant Acinetobacter baumannii,9.8%were multidrug-resistant Pseudomonas aeruginosa,and 6.1%were carbapenem-resistant Escherichia coli.Identified risk factors included smoking history,total hospitalization days,ICU stay length,hypoproteinemia,indwelling gastric tube,intubation type,duration of mechanical ventilation,usage of antibacterial drugs,and administration of protein drugs(P<0.05).Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients(P<0.05).Conclusion:ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii.To prevent LRTIs in patients,tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.展开更多
AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients wi...AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous exposure to fluoroquinolones(OR=9.29;95%CI:1.16-74.284,P=0.036)were independently associated with severe CDI.CONCLUSION:We report predictors of severe CDI not dependent on time of assessment.Such factors could help in the development of a quantitative score in ICU’s patients.展开更多
目的探讨重症监护室(intensive care unit,ICU)住院患者中应用循环质控理念联合风险管理模式的效果。方法选取2023年1—5月寿光市人民医院ICU住院患者335例作为对照组,实施常规医院感染管理;选取2023年6—12月ICU住院患者340例作为干预...目的探讨重症监护室(intensive care unit,ICU)住院患者中应用循环质控理念联合风险管理模式的效果。方法选取2023年1—5月寿光市人民医院ICU住院患者335例作为对照组,实施常规医院感染管理;选取2023年6—12月ICU住院患者340例作为干预组,实施循环质控理念联合风险管理模式。比较2组管理质量、风险事件、医院感染发生率及患者满意度。结果干预组管理质量(感染监测、组织管理、风险评估、制度建设)评分高于对照组(P<0.05);干预组风险事件发生率(1.47%)低于对照组(4.48%)(P<0.05);干预组医院感染发生率(3.82%)低于对照组(7.46%)(P<0.05);干预组患者满意度(98.24%)低于对照组(95.52%)(P<0.05)。结论循环质控理念联合风险管理模式应用于ICU住院患者中,可提高管理质量,减少风险事件与医院感染发生,促进患者满意度提升,体现了《ICU十大安全目标》的执行标准。展开更多
目的探究重症监护室(intensive care unit,ICU)更年期女性患者入住时间延长的危险因素并构建预测模型。方法选取2019年6月至2022年12月台州市中心医院ICU住院的更年期女性260例为研究对象,根据患者ICU住院时间将其分为延长组(≥5d,156例...目的探究重症监护室(intensive care unit,ICU)更年期女性患者入住时间延长的危险因素并构建预测模型。方法选取2019年6月至2022年12月台州市中心医院ICU住院的更年期女性260例为研究对象,根据患者ICU住院时间将其分为延长组(≥5d,156例)和未延长组(<5d,104例)。收集患者的临床资料,采用多因素Logistic回归分析ICU患者住院时间延长的影响因素,构建列线图预测模型,绘制受试者操作特征曲线并计算曲线下面积(area under the curve,AUC)。结果延长组患者的昏迷、进行侵袭操作及使用广谱抗生素的占比均显著高于未延长组(P<0.05);延长组患者的血压异常、肌肉/骨关节疼痛、心率异常、呼吸功能异常及感染发生率均显著高于未延长组患者(P<0.05);多因素Logistic回归分析结果显示,昏迷、侵袭操作、使用广谱抗生素、血压异常、心率异常、呼吸功能异常、感染均是导致更年期女性ICU住院时间延长的危险因素(P<0.05);构建的列线图模型拟合度良好(χ^(2)=5.072,P=0.285);列线图模型预测患者ICU住院时间延长的AUC为0.857(95%CI:0.778~0.937),敏感度为78.16%,特异性为83.67%。结论意识状态不稳定、侵袭操作、使用广谱抗生素、血压异常、心率异常、呼吸功能异常、感染均是导致更年期女性ICU住院时间延长的危险因素,临床上应密切关注并及时给予针对性治疗。展开更多
目的分析风险评估联合计划-执行-检查-处理(plan-do-check-act,PDCA)循环法在多重耐药菌感染(multiple drug-resistant organism,MDRO)防控中的应用效果。方法选取2021年7月—2023年6月菏泽市中医医院重症加强护理病房(intensive care u...目的分析风险评估联合计划-执行-检查-处理(plan-do-check-act,PDCA)循环法在多重耐药菌感染(multiple drug-resistant organism,MDRO)防控中的应用效果。方法选取2021年7月—2023年6月菏泽市中医医院重症加强护理病房(intensive care unit,ICU)收治的患者360例,按照干预时间将2021年7月—2022年6月的180例患者作为对照组,2022年7月—2023年6月的180例患者作为研究组。对照组采取常规管理措施防控MDRO,研究组在其基础上采用风险评估联合PDCA循环法进行MDRO防控。比较2组MDRO防控措施的执行情况与MDRO的检出率。结果研究组的危急值报告、规范隔离、开具隔离医嘱、诊疗用品专用、诊疗时个人防护、手卫生、终末消毒的执行情况评分均高于对照组,差异有统计学意义(P<0.05)。研究组MDRO检出率为5.56%,低于对照组的12.22%(P<0.05)。结论风险评估与PDCA循环法联合应用可以进一步提升MDRO防控工作的执行情况,降低MDRO发生风险。展开更多
基金the National Natural Science Foundation of China,No.81801284and the National Natural Science Foundation of Jilin Province,No.YDZJ202201ZYTS091.
文摘Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,which are closely related to ICU-acquired weakness(ICUAW).It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors.ICU-AW is the most common neuromuscular injury in the ICU,which affects clinical progression and outcomes of patients.This manuscript helps to improve the early recognition of ICU-AW,thereby reducing mortality and improving prognosis.
基金Analysis of influencing factors and direct economic losses of ICU infection in a newly built tertiary comprehensive hospital(Project No:Qiankehe Support[2021]General 043)。
文摘Objective:This study aims to explore the prevalence,features,and risk factors of lower respiratory tract infections(LRTIs)in the intensive care unit(ICU)of a newly established hospital in Zunyi City.The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals,thereby mitigating the incidence of nosocomial LRTIs in ICU patients.Methods:A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City.Patients with LRTIs constituted the case group,while those without LRTIs constituted the control group,where a 1:1 matching principle was adhered to.A single-factor chi-square(χ2)test was employed to analyze the risk factors,with independent risk factors being explored using a multivariate logistic regression analysis.Results:A total of 169 strains of pathogenic bacteria were isolated,comprising 66.28%gram-negative bacteria,17.75%gram-positive bacteria,and 15.97%fungi.The most prevalent pathogens included Acinetobacter baumannii(43.20%),Candida albicans(10.65%),and Pseudomonas aeruginosa(8.88%).Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs,81.7%were carbapenem-resistant Acinetobacter baumannii,9.8%were multidrug-resistant Pseudomonas aeruginosa,and 6.1%were carbapenem-resistant Escherichia coli.Identified risk factors included smoking history,total hospitalization days,ICU stay length,hypoproteinemia,indwelling gastric tube,intubation type,duration of mechanical ventilation,usage of antibacterial drugs,and administration of protein drugs(P<0.05).Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients(P<0.05).Conclusion:ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii.To prevent LRTIs in patients,tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.
基金Supported by A grant for her PhD from Sanofi Pasteur,France,to Khanafer N
文摘AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous exposure to fluoroquinolones(OR=9.29;95%CI:1.16-74.284,P=0.036)were independently associated with severe CDI.CONCLUSION:We report predictors of severe CDI not dependent on time of assessment.Such factors could help in the development of a quantitative score in ICU’s patients.
文摘目的探讨重症监护室(intensive care unit,ICU)住院患者中应用循环质控理念联合风险管理模式的效果。方法选取2023年1—5月寿光市人民医院ICU住院患者335例作为对照组,实施常规医院感染管理;选取2023年6—12月ICU住院患者340例作为干预组,实施循环质控理念联合风险管理模式。比较2组管理质量、风险事件、医院感染发生率及患者满意度。结果干预组管理质量(感染监测、组织管理、风险评估、制度建设)评分高于对照组(P<0.05);干预组风险事件发生率(1.47%)低于对照组(4.48%)(P<0.05);干预组医院感染发生率(3.82%)低于对照组(7.46%)(P<0.05);干预组患者满意度(98.24%)低于对照组(95.52%)(P<0.05)。结论循环质控理念联合风险管理模式应用于ICU住院患者中,可提高管理质量,减少风险事件与医院感染发生,促进患者满意度提升,体现了《ICU十大安全目标》的执行标准。
文摘目的探究重症监护室(intensive care unit,ICU)更年期女性患者入住时间延长的危险因素并构建预测模型。方法选取2019年6月至2022年12月台州市中心医院ICU住院的更年期女性260例为研究对象,根据患者ICU住院时间将其分为延长组(≥5d,156例)和未延长组(<5d,104例)。收集患者的临床资料,采用多因素Logistic回归分析ICU患者住院时间延长的影响因素,构建列线图预测模型,绘制受试者操作特征曲线并计算曲线下面积(area under the curve,AUC)。结果延长组患者的昏迷、进行侵袭操作及使用广谱抗生素的占比均显著高于未延长组(P<0.05);延长组患者的血压异常、肌肉/骨关节疼痛、心率异常、呼吸功能异常及感染发生率均显著高于未延长组患者(P<0.05);多因素Logistic回归分析结果显示,昏迷、侵袭操作、使用广谱抗生素、血压异常、心率异常、呼吸功能异常、感染均是导致更年期女性ICU住院时间延长的危险因素(P<0.05);构建的列线图模型拟合度良好(χ^(2)=5.072,P=0.285);列线图模型预测患者ICU住院时间延长的AUC为0.857(95%CI:0.778~0.937),敏感度为78.16%,特异性为83.67%。结论意识状态不稳定、侵袭操作、使用广谱抗生素、血压异常、心率异常、呼吸功能异常、感染均是导致更年期女性ICU住院时间延长的危险因素,临床上应密切关注并及时给予针对性治疗。
文摘目的分析风险评估联合计划-执行-检查-处理(plan-do-check-act,PDCA)循环法在多重耐药菌感染(multiple drug-resistant organism,MDRO)防控中的应用效果。方法选取2021年7月—2023年6月菏泽市中医医院重症加强护理病房(intensive care unit,ICU)收治的患者360例,按照干预时间将2021年7月—2022年6月的180例患者作为对照组,2022年7月—2023年6月的180例患者作为研究组。对照组采取常规管理措施防控MDRO,研究组在其基础上采用风险评估联合PDCA循环法进行MDRO防控。比较2组MDRO防控措施的执行情况与MDRO的检出率。结果研究组的危急值报告、规范隔离、开具隔离医嘱、诊疗用品专用、诊疗时个人防护、手卫生、终末消毒的执行情况评分均高于对照组,差异有统计学意义(P<0.05)。研究组MDRO检出率为5.56%,低于对照组的12.22%(P<0.05)。结论风险评估与PDCA循环法联合应用可以进一步提升MDRO防控工作的执行情况,降低MDRO发生风险。
