目的:血流感染(BSIs)是医院内威胁生命的主要感染之一。他们负责延长住院时间,医疗费用高,和显著的死亡率。BSI的流行病学因医院而异,需要分析当地趋势。很少有关于创伤患者的研究,由于存在多个侵入性设备而容易受到影响。
方法:从4月开始在1级创伤中心对所有BSI进行前瞻性监测,2011年3月,2012.主治医师每天对所有进入不同创伤重症监护病房(ICU)的患者进行监测,以进行随后的医院BSI发展。当患者出现以下一种或多种体征/症状时,发现BSI发作:也就是说,发烧,体温过低,发冷,或低血压和至少一个或多个血液培养样品证明了病原菌的生长。根据疾病控制和预防中心的定义,BSI进一步分为一级和二级BSI。随访所有发生医院BSI的患者,直至其最终结果。
结果:在240例患者中观察到总共296次医院BSI发作。在155次(52%)发作中确定了BSI的来源。呼吸机相关性肺炎是继发性BSI的最常见来源。最常见的生物是不动杆菌。(21.5%)。念珠菌sp.占所有血流生物的12%。在革兰氏阴性和阳性病原体中观察到高的抗菌素耐药性。
结论:创伤患者的BSI患病率较高。由于继发性菌血症更常见,有针对性的预防个体感染的方法将有助于减轻BSI的负担.
OBJECTIVE: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices.
METHODS: A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome.
RESULTS: A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens.
CONCLUSIONS: Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.