全国医院感染监测网2012年综合ICU医院感染现患率调查监测报告

Survey on healthcareassociated infection in general intensive care units reported to China HAI Surveillance Network

摘要:

目的了解我国医院综合重症监护室（ICU）医院感染发生率、常见侵入性操作使用率及相关感染率、抗菌药物使用及病原体分布情况。方法对2012年3月15日—12月31日期间上报至全国医院感染监测网医院感染横断面调查资料中综合ICU监测数据进行汇总分析。结果1 313所医院中，621所（47.30%）有综合ICU；共监测患者5 887例，发生医院感染1 634例、1 962例次，医院感染现患率及例次现患率分别为27.76%、33.33%。医院感染部位以下呼吸道（70.39%）居首位，其次为泌尿道（12.79%）、血液（2.86%）。泌尿道插管、动静脉置管及呼吸机使用率分别达53.52%（3 151例）、37.05%（2 181例）、35.62%（2 097例），其相关泌尿道感染、肺炎、血流感染现患率分别为4.67%、20.41%、0.60%，分别占泌尿道、肺炎、血流现患医院感染的58.57%、30.99%、23.21%，三者合计占医院感染现患率29.97%（588/1 962）。检出医院感染病原体1 795株，居前3位的分别是铜绿假单胞菌（20.78%）、鲍曼不动杆菌(17.99%)和肺炎克雷伯菌(11.64%)。抗菌药物使用率为71.58%（4 214例），病原学送检率达75.27%（2 553/3 392）。结论综合ICU住院患者医院感染现患率以及抗菌药物使用率高，各种侵入性操作（泌尿道插管率、动静脉置管率和呼吸机使用率）高，30%的医院感染与侵入性操作相关；非发酵菌感染严重，病原学送检率尚可。

关键词:

医院感染; 现患率调查; 重症监护室; 现患率; 泌尿道插管相关泌尿道感染; 血管导管相关血流感染; 呼吸机相关肺炎; 病原体; 抗菌药物

Abstract:

ObjectiveTo realize the incidence of healthcareassociated infection (HAI),the rate of invasive procedure and related infection rate, use of antimicrobial agents and distribution of pathogens in gereral intensive care units (GICUs) of hospitals in China. MethodsHAI crosssectional investigation data  of GICUs reported to China HAI Surveillance Network were summarized and analyzed.ResultsOf 1 313 hospitals, 621（47.30%）had GICUs；a total of 5 887 patients were surveyed, 1 634 patients developed 1 962 times of infection，HAI prevalence rate and case rate was 27.76% and 33.33% respectively. The main infection sites were lower respiratory tract（70.39%），urinary tract （12.79%） and blood（2.86%）.The application rate of urinary catheter, arteriovenous catheter and ventilator was 53.52%（n=3 151）,37.05%（n=2 181）and 35.62%（n=2 097）respectively，and related prevalence of urinary tract infection, pneumonia and blood stream infection was 4.67%,20.41%, and 0.60%，respectively，which accounting for 58.57%,30.99%, and 23.21% of urinary tract infection, pneumonia and blood stream infection respectively, the overall prevalence of above invasive procedurerelated infection accounted for 29.97%（588/1 962）of the overall HAI prevalence.A total of 1 795 isolated pathogens causing HAI were detected，the top three were Pseudomonas aeruginosa（20.78%）, Acinetobacter baumannii (17.99%) and Klebsiella pneumoniae (11.64%). The usage rate of antimicrobial agents was 71.58%（n=4 214），rate of specimens delivered for detection  was up to 75.27%（2 553/3 392）.ConclusionPrevalence and antimicrobial use in patients in GICUs are all high, all kinds of invasive procedure are frequent, 30% of HAI are related to invasive procedure; infection caused by nonfermentative bacteria is serious, pathogen detection is well performed.

Key words:

healthcareassociated infection; prevalence survey; intensive care unit; prevalence rate; urinary catheterrelated urinary tract infection; intravascular catheterrelated blood stream infection; ventilatorassociated pneumonia; pathogen; antimicrobial agent