2015-2018年某省158家医院ICU呼吸机相关肺炎监测分析
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摘要
目的了解某省不同地域、性质及等级医院ICU呼吸机相关肺炎(VAP)发病情况及变化趋势。方法对2015-2018年158家省医院感染监控网医院ICU VAP进行目标性监测。结果 2015-2018年,VAP发生水平总体呈下降趋势。二级医院VAP千日感染率(20.17～8.66‰,M=11.95)高于三级医院(15.25～6.74‰,M=7.34)(Z=11.635,P<0.001)。不同性质医院中,综合性医院与中医院VAP发生水平无统计学差异(Z=0.615,P=0.539),与综合性医院相比,妇幼专科医院最低(3.65‰)(Z=-7.610,P<0.001),其他专科类医院最高(11.53‰)(Z=5.560,P<0.001)。赣北与赣南地区VAP发生水平无统计学差异(Z=1.747,P=0.081),赣中地区低于赣北地区(Z=-4.176,P<0.001),赣北与赣南地区VAP发生水平呈下降趋势(赣北χ~2=75.909,P<0.001;赣南χ~2=53.071,P<0.001)。ICU患者有创通气使用率与VAP发生水平无相关性(P>0.05)。结论持续加强ICU VAP的监控,并定期分析、反馈和查找高危因素,为采取针对性防控策略提供依据,可有效降低ICU VAP发病率。
OBJECTIVE To understand the prevalence and trend of ventilator-associated pneumonia(VAP) in ICUs of hospitals of different regions, nature and grades in a province. METHODS A targeted surveillance was conducted for VAP in the ICUs of 158 hospitals through provincial hospital infection surveillance network from 2015 to 2018. RESULTS The overall incidence of VAP showed a downward trend from 2015 to 2018. The thousand-day infection rate was 20.17～8.66‰(M=11.95) in the secondary hospitals, significantly higher than 15.25～6.74‰(M=7.34)in the tertiary hospitals(Z=11.635,P<0.001). There was no significant difference in the incidence of VAP between the general hospitals and the TCM hospitals( Z=0.615,P=0.539); as compared with the general hospitals, the incidence of VAP was the lowest(3.65%) in the maternal and child hospitals(Z=-7.610,P<0.001) and was the highest(11.53%) in other specialist hospitals(Z=5.560,P<0.001). There was no significant difference in the incidence of VAP between the northern Jiangxi province and southern Jiangxi province(Z=1.747,P=0.081), the incidence of VAP was significantly lower in the middle Jiangxi province than in the northern Jiangxi province(Z=-4.176,P<0.001); the incidence of VAP showed a downward trend in the northern and southern Jiangxi province(northern Jiangxi province χ~2=75.909,P<0.001;southern Jiangxi province χ~2=53.071,P<0.001). The rate of invasive ventilation was not associated with the incidence of VAP(P>0.05). CONCLUSION It is an effective way to continuously strengthen the surveillance of VAP in ICUs, regularly analyze, feed back and find out high risk factors and take targeted prevention measures so as to reduce the incidence of VAP in ICUs.
OBJECTIVE To understand the prevalence and trend of ventilator-associated pneumonia(VAP) in ICUs of hospitals of different regions, nature and grades in a province. METHODS A targeted surveillance was conducted for VAP in the ICUs of 158 hospitals through provincial hospital infection surveillance network from 2015 to 2018. RESULTS The overall incidence of VAP showed a downward trend from 2015 to 2018. The thousand-day infection rate was 20.17～8.66‰(M=11.95) in the secondary hospitals, significantly higher than 15.25～6.74‰(M=7.34)in the tertiary hospitals(Z=11.635,P<0.001). There was no significant difference in the incidence of VAP between the general hospitals and the TCM hospitals( Z=0.615,P=0.539); as compared with the general hospitals, the incidence of VAP was the lowest(3.65%) in the maternal and child hospitals(Z=-7.610,P<0.001) and was the highest(11.53%) in other specialist hospitals(Z=5.560,P<0.001). There was no significant difference in the incidence of VAP between the northern Jiangxi province and southern Jiangxi province(Z=1.747,P=0.081), the incidence of VAP was significantly lower in the middle Jiangxi province than in the northern Jiangxi province(Z=-4.176,P<0.001); the incidence of VAP showed a downward trend in the northern and southern Jiangxi province(northern Jiangxi province χ~2=75.909,P<0.001;southern Jiangxi province χ~2=53.071,P<0.001). The rate of invasive ventilation was not associated with the incidence of VAP(P>0.05). CONCLUSION It is an effective way to continuously strengthen the surveillance of VAP in ICUs, regularly analyze, feed back and find out high risk factors and take targeted prevention measures so as to reduce the incidence of VAP in ICUs.
引文
[1] 重症监护病房医院感染预防与控制规范 WS/T 509-2016[J].中国感染控制杂志,2017,16(2):191-194.
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[3] Nair GB,Niederman MS.Ventilator-associated pneumonia:present understanding and ongoing debates[J].Intensive Care Med,2015,41(1):34-48.
[4] Wang HM,Zhang XH,Wang J.Methodological questions regarding a meta-analysis of the burden of healthcare-associatedinfections in Southeast Asia[J].Clin Infect Dis,2016,63(3):428-429.
[5] Luckraz H,Manga N,Senanayake EL,et al.Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service:results from a propensity-matched cohort study[J].J Intensive Care Soc,2018,19(2):94-100.
[6] Alp E,Cookson B,Erdem H,et al.Infection control bundles in intensive care:an international cross-sectional survey in low- and middle-income countries[J].J Hosp Infect,2019,101(3):248-256.
[7] 周宏,姜亦虹,李阳,等.176所医院连续6年ICU医院感染目标性监测分析[J].中国感染控制杂志,2017,16(9):810-815.
[8] Dudeck MA,Edwards JR,Allen-Bridson K,et al.National Healthcare Safety Network report,data summary for 2013,device-associated Module[J].Am J Infect Control,2015,43(3):206-221.
[9] Rosenthal VD,Al-Abdely HM,El-Kholy AA,et al.International Nosocomial Infection Control Consortium report,data summary of 50 countries for 2010-2015:device-associated module[J].Am J Infect Control,2016,44(12):1495-1504.
[10] 张会平,史广鸿,田真,等.风险管理在重症监护病房导管相关感染防控中的应用[J].中国感染控制杂志,2016,15(8):618-620.
[11] Afhami S,Seifi A,Hajiabdolbaghi M,et al.Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran[J].East Mediterr Health J,2019,25(2):90-97.
[12] 中华医学会呼吸病学分会感染学组.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核和呼吸杂志,2018,41(4):255-280.
[13] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会呼吸学组,中华医学会儿科学分会急救学组,等.儿童医院获得性肺炎管理方案(2010版)[J].中华儿科杂志,2011,49(2).
[14] Kesinger MR,Kumar RG,Wagner AK,et al.Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge[J].J Trauma Acute Care Surg,2015,78(2):396-402.
[15] 周宏,姜亦虹,沈黎,等.二级医院与三级医院ICU医院感染目标性监测对比分析[J].中华医院感染学杂志,2013,23(7):1515-1517.
[16] 李六亿,李洪山,郭燕红,等.加强医院感染防控能力建设,提升医院感染管理水平[J].中国感染控制杂志,2015,14(8):507-512.
[17] 吕建飞,朱军.二级和三级医院ICU医院感染目标性监测的对照研究[J].中国社区医师,2018,34(11):75-76.
[18] 陈胜龙,陈纯波.美国《急重症医院呼吸机相关性肺炎预防策略(2014版)》解读[J].中国实用内科杂志,2015,35(7):591-594.
[19] Park SA,Cho SS,Kwak GJ.Factors influencing ventilator-associated pneumonia in cancer patients[J].Asian Pac J Cancer Prev,2014,15(14):5787-5791.
[20] de Neef M,Bakker L,Dijkstra S,et al.Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the PICU:a systematic review and meta-analysis[J].Pediatr Crit Care Med,2019,20(5):474-480.
[21] 陈修文,张小康,罗晓黎.2009-2011年医院感染目标性监测结果及变化趋势[J].中华医院感染学杂志,2013,23(7):1507-1509.
[2] Barbier F,Andremont A,Wolff M,et al.Hospital-acquired pneumonia and ventilator-associated pneumonia:recent advances in epidemiology and management[J].Curr Opin Pulm Med,2013,19(3):216-228.
[3] Nair GB,Niederman MS.Ventilator-associated pneumonia:present understanding and ongoing debates[J].Intensive Care Med,2015,41(1):34-48.
[4] Wang HM,Zhang XH,Wang J.Methodological questions regarding a meta-analysis of the burden of healthcare-associatedinfections in Southeast Asia[J].Clin Infect Dis,2016,63(3):428-429.
[5] Luckraz H,Manga N,Senanayake EL,et al.Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service:results from a propensity-matched cohort study[J].J Intensive Care Soc,2018,19(2):94-100.
[6] Alp E,Cookson B,Erdem H,et al.Infection control bundles in intensive care:an international cross-sectional survey in low- and middle-income countries[J].J Hosp Infect,2019,101(3):248-256.
[7] 周宏,姜亦虹,李阳,等.176所医院连续6年ICU医院感染目标性监测分析[J].中国感染控制杂志,2017,16(9):810-815.
[8] Dudeck MA,Edwards JR,Allen-Bridson K,et al.National Healthcare Safety Network report,data summary for 2013,device-associated Module[J].Am J Infect Control,2015,43(3):206-221.
[9] Rosenthal VD,Al-Abdely HM,El-Kholy AA,et al.International Nosocomial Infection Control Consortium report,data summary of 50 countries for 2010-2015:device-associated module[J].Am J Infect Control,2016,44(12):1495-1504.
[10] 张会平,史广鸿,田真,等.风险管理在重症监护病房导管相关感染防控中的应用[J].中国感染控制杂志,2016,15(8):618-620.
[11] Afhami S,Seifi A,Hajiabdolbaghi M,et al.Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran[J].East Mediterr Health J,2019,25(2):90-97.
[12] 中华医学会呼吸病学分会感染学组.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核和呼吸杂志,2018,41(4):255-280.
[13] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会呼吸学组,中华医学会儿科学分会急救学组,等.儿童医院获得性肺炎管理方案(2010版)[J].中华儿科杂志,2011,49(2).
[14] Kesinger MR,Kumar RG,Wagner AK,et al.Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge[J].J Trauma Acute Care Surg,2015,78(2):396-402.
[15] 周宏,姜亦虹,沈黎,等.二级医院与三级医院ICU医院感染目标性监测对比分析[J].中华医院感染学杂志,2013,23(7):1515-1517.
[16] 李六亿,李洪山,郭燕红,等.加强医院感染防控能力建设,提升医院感染管理水平[J].中国感染控制杂志,2015,14(8):507-512.
[17] 吕建飞,朱军.二级和三级医院ICU医院感染目标性监测的对照研究[J].中国社区医师,2018,34(11):75-76.
[18] 陈胜龙,陈纯波.美国《急重症医院呼吸机相关性肺炎预防策略(2014版)》解读[J].中国实用内科杂志,2015,35(7):591-594.
[19] Park SA,Cho SS,Kwak GJ.Factors influencing ventilator-associated pneumonia in cancer patients[J].Asian Pac J Cancer Prev,2014,15(14):5787-5791.
[20] de Neef M,Bakker L,Dijkstra S,et al.Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the PICU:a systematic review and meta-analysis[J].Pediatr Crit Care Med,2019,20(5):474-480.
[21] 陈修文,张小康,罗晓黎.2009-2011年医院感染目标性监测结果及变化趋势[J].中华医院感染学杂志,2013,23(7):1507-1509.