导管相关血流感染临床分析

目的 分析我院2008年1月至2010年12月重症监护病房(ICU)和普通病房导管相关血流感染(CRBSI)的发生情况,为CRBSI的预防和治疗提供依据.方法 将我院131例CRBSI病例分为ICU组和普通病房组,对临床资料、病原菌、导管位置、预后等进行回顾性分析.结果 ICU组(88例)和普通病房组(43例)在年龄和...     

综合重症监护病房院内感染病原菌分布及耐药性分析

目的 了解中心重症监护病房院内感染流行病学特点及细菌耐药性情况.方法 对本院中心重症监护病房2006年8月至2008年8月所分离致病菌的菌群分布及其耐药情况进行回顾性分析.结果 重症监护病房中共有214例发生院内感染,院内感染率为23.86%.共分离出致病菌493株,以革兰阴性杆菌为主,占58.01%,其中比例最高的为鲍曼不动杆菌(19.27%),其次为铜绿假单胞菌(8.92%)、肺炎克雷伯菌(6.90%).革兰阳性球菌占38.54%,比例最高为金黄色葡萄球菌(12.58%).真菌占3.45%.结论 革兰阴性杆菌仍为重症监护病房院内感染主要病原菌,其中非发酵菌比例较高,且呈现多重耐药趋势.合理使用抗生素,尽快完善各项病原学检查,减少高危因素并制定有效的防治措施显得更加重要.     

Risk factors and microbial profile of central venous catheter related blood stream infection in medical cardiac care units,National Heart Institute,Egypt

Introduction

Catheter related blood stream infection (CRBSI) is the main complication of central venous catheter (CVC) use. The aim of the study is to improve the safety of patients with central venous catheter in National Heart Institute (NHI) medical cardiac care units.

重症监护室耐药非发酵革兰阴性菌院内感染的危险因素及治疗进展研究

多耐药非发酵革兰阴性菌已成为重症监护室院内感染的重要病原菌,近年来其检出率在全球有逐年上升的趋势,对其危险因素和治疗进展的探讨具有重要意义.入院前有抗生素使用史、反复插管、最初不恰当抗生素治疗即病原菌对所用抗菌药物不敏感、重症监护室住院时间延长等是耐药菌院内感染常见的危险因素.关于耐药菌院内感染的治疗,采用早期适当联合用药原则,控制感染.     

Methicillin-resistant Staphylococcus aureus in a Canadian intensive care unit: Delays in initiating effective therapy due to the low prevalence of infection

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta. METHODS: A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005. RESULTS: Forty-six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in-hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed-field gel electrophoresis. Hospital-acquired strains were predominantly CMRSA-2 (59%), indicating that this clone circulates at the University of Alberta Hospital. CONCLUSIONS: MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community-acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital-acquired strains were CMRSA-2.     

75岁以上高龄患者心脏手术后重症监护医院感染分析

目的：调查重症监护病房高龄心脏手术患者术后医院感染及病原菌耐药性,以指导临床合理使用抗菌药物。方法：回顾性分析2005年1月至2012年10月,我院心脏外科75岁以上高龄患者术后医院感染临床资料,纸片扩散（K-B）法进行药敏实验。结果：2005年1月至2012年10月75岁以上高龄患者行开胸心脏手术1 361例,100例患者发生医院感染,感染率7.3%。合并糖尿病患者医院感染发生率显著高于非糖尿病患者;发生医院感染的高龄心脏手术患者住院时间、住院费用及病死率显著高于未发生医院感染的高龄患者。分离各种病原菌165株,其中呼吸道101株,占61.2%;血液29株,占17.6%;其他各类病原菌35株,占21.2%。革兰氏阴性菌中以鲍曼不动杆菌为主（20.6%）,革兰氏阳性菌中以表皮葡萄球菌为主（7.2%）,真菌中以白色假丝酵母菌为主（22.4%）。鲍曼不动杆菌显示多种药物为100%耐药。溶血性葡萄球菌及金黄色葡萄球菌显示多药耐药。呋喃妥因及万古霉素对革兰氏阳性球菌抗菌活性均为100%。结论：高龄心脏手术患者术后医院感染主要发生在呼吸道,耐药性逐渐增加,围手术期应合理使用抗菌药物,减轻患者负担,降低高龄患者住院病死率。     

Chlorhexidine impregnated central venous catheter inducing an anaphylatic shock in the intensive care unit

Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity. Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access. Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters.     

ICU中心静脉导管相关血行感染的病原菌及耐药性分析

目的探讨外科ICU中心静脉导管相关血行感染的细菌定植、感染的发生率、药物敏感性以及相关危险因素。为临床预防和治疗提供依据。方法回顾性分析疑似中心静脉导管感染病例,根据血培养和导管尖端培养结果,观察导管相关感染的发生率和病原菌分布及耐药情况并进行统计分析。结果疑似中心静脉导管感染患者143例中,确诊导管相关性血行感染（CRBSI）31例,发生率为21．7％（31／143）;共分离出病原菌31株：鲍曼不动杆菌8株（25．8％）、真菌6株（19．3％）、铜绿假单胞菌4株（12．9％）、凝固酶阴性葡萄球菌4株（12．9％）。结论鲍曼不动杆菌和真菌是外科ICU中心静脉导管相关血行感染的主要致病菌,医务人员应加强重视并早期监测,并根据药敏结果适时调整抗菌药物。     

Impact of Candida species on clinical outcomes in patients with suspected ventilator-associated pneumonia

BACKGROUND:

The significance of Candida species in respiratory tract (RT) secretions in critically ill patients is unclear.

METHODS:

A retrospective analysis of the Canadian ventilator-associated pneumonia (VAP) trial was conducted. Only patients with suspected VAP whose initial cultures failed to grow any known pathogens were included. Using two fundamentally different statistical techniques that adjusted for important confounding variables, the clinical outcomes of patients with Candida species recovered from RT cultures were compared with patients whose RT cultures were not positive for Candida species.

RESULTS:

RT cultures yielded no identifiable bacterial pathogens in 274 patients; 68 patients had Candida species in the RT alone, while 206 patients did not have Candida species recovered from any site. The unadjusted OR of hospital mortality for patients with Candida species was 2.9 (95% CI 1.6 to 5.2; P<0.001). The hazard ratio of time to hospital discharge was 0.54 (95% CI 0.38 to 0.77; P=0.001). Logistic regression analysis demonstrated that age, Acute Physiology score and Chronic Health Evaluation (APACHE) II score, primary diagnosis of respiratory failure, two or more comorbidities and Candida species were independently associated with increased hospital mortality. Similar trends were observed with time to hospital discharge. The association between Candida species and increased mortality remained after controlling for potential confounders using both propensity score stratification and multivariable modelling approaches.

CONCLUSIONS:

Patients with suspected VAP, in whom no bacterial pathogen was identified and in whom Candida species were isolated from RT cultures, exhibited a greater burden of illness compared with similar patients without Candida. Whether Candida species colonization of RT secretions is a marker of disease severity or actually contributes to poorer clinical outcomes remains unclear.     

Incidence of catheter-related bloodstream infection in a general hospital using two different detection methods

Introduction

The aim of this study was to determine the incidence of central venous catheter-related bloodstream infection (CRBSI) in a general hospital, using two different assessment methods.

Methods

Method A: One observer prospectively followed up all patients with central venous catheters (CVCs) placed in our hospital over a period of 1 year, recording all CRBSI episodes. Incidence was calculated in two ways, in relation to the total number of catheter days, and in relation to the total number of hospital days of all patients hospitalized during this period. Method B: Another observer recorded all CRBSI episodes diagnosed during the same time period using microbiology data in which blood culture and catheter culture were positive for the same microorganism. Incidence was calculated in relation to the total number of hospital days of all hospitalized patients.The patient's demographic characteristics and the catheter-related variables were recorded and analysed. Based on clinical and microbiological criteria, catheters were classified as uninfected, colonized, or CRBSI.

Results

Over the study period, 878 central venous catheters were placed in 704 patients. The total number of catheter days was 7357, and the mean duration of catheter use was 8.15 days (1–86). The total number of hospital stays in this period was 92,167.Method A: 15 episodes of CRBSI were detected, yielding an overall incidence of 2.03 episodes/1000 catheter days or 0.16 episodes/1000 hospital days. Method B: 11 episodes of CRBSI, with an incidence of 0.12 episodes/1000 hospital days.

Conclusion

The two methods studied yielded different CRBSI rates, with a higher incidence reported by prospective follow-up (Method A). In addition, this method enabled a better assessment to be made of CRBSI risk as the calculation could be performed in relation to the days patients were catheterized.     

ICU侵袭性真菌感染80例回顾性分析

目的探讨ICU患者侵袭性真菌感染的临床特点,以提高临床医生对侵袭性真菌感染的认识。方法对2008年1月～2009年12月我院ICU确诊的80例侵袭性真菌感染患者的临床资料进行回顾性分析。结果80例患者均存在基础疾病及感染诱因,感染部位依次为呼吸道（39．6％）、泌尿道（22．9％）、消化道（16．7％）、腹腔（10．4％）、血液（8．3％）和颅内（2．1％）,病原菌以白色念珠菌为主（56．0％）,但非白色念珠菌有上升趋势;患者病死率高（43．8％）,病程中具有某些有意义的临床表现征象。结论ICU侵袭性真菌感染易患因素较多,发病呈上升趋势,且病死率高,充分了解其临床特点,对早期诊治有重要意义。     

重症监护室老年患者中心静脉导管相关血流感染的危险因素

目的探讨重症监护室（ICU）老年患者导管相关血流感染（CRBSI）的危险因素。方法ICU90例老年住院患者接受中心静脉置管,分为导管相关性血流感染（CRBSI）组和无感染（对照）组。CRBSI组患者为ICU住院的行深静脉置管伴CRBSI的病例（n=45）,而对照组为同期ICU住院的行深静脉置管但无CRBSI的病例（17=45）,采用回顾性和病例对照的研究方法,对两组患者进行风险困素分析。结果两组患者基础疾病构成、年龄、性别、感染前导管留鼍时间、机械通气、完全肠外营养、尿管留置等的差异无统计学意义（P〉0．05）。与对照组比较,CRBSI组使用碳青霉烯类抗生素、操作熟练程度、置管部位、低白蛋白血症、贫血、APACHEII评分差异有统计学意义（P〈0．01、P〈0．05）。使用碳青霉烯类抗生素、操作者、低A蛋白血症、APACHEII评分是CRBSI独立危险因素。结论碳青霉烯类抗生素使用、操作者人员熟练程度、低白蛋A血症及APACHEII评分是ICU老年患者CRBSI的独立危险因素。