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

摘要:

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ICU 2013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。

Abstract:

ObjectiveTo 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 measures, and scientific diagnosis and treatment for patients.  MethodsTargeted monitoring data on healthcareassociated infection (HAI) in ICUs of 32 hospitals in a province in 2013 were investigated retrospectively. ResultsThe incidence of ICULRTI was 5.79%, ventilator usage rate  was 31.25%, incidence of ventilatorassociated pneumonia(VAP) was 26.93‰;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, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli, accounting for 25.49%, 15.26%, 14.63%, 13.37% and 5.09% respectively.ConclusionTargeted 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.