医院感染流行病学研究
|
摘要
一、研究目的
本研究旨在利用描述性、分析性和理论流行病学研究方法,调查湖北省医院感染患病情况及影响因素、呼吸机相关性肺炎和导管相关性尿路感染发病及危险因素,构建医院感染预测模型,抽样调查全国部分省市医疗机构医院感染暴发应急现状并提出对策和建议。
二、研究方法
1、抽样调查湖北省三级甲等医院住院患者医院感染患病情况。调查采用统一方法进行,收集调查日当天所有住院患者信息,包括性别、年龄、当前诊断、医院感染和微生物培养结果、抗菌药物使用情况等。医院感染诊断标准采用卫生部2001年《医院感染诊断标准(试行)》。
2、在湖北省17所三级甲等医院ICU中开展呼吸机相关性肺炎多中心前瞻性队列研究,随访入住ICU超过48小时且接受机械通气的患者呼吸机相关性肺炎的发病及危险因素暴露情况。应用logistic回归分析呼吸机相关性肺炎危险因素。
3、在湖北省某三级甲等医院入住ICU且接受尿路插管的患者中开展巢式病例对照研究,随访接受尿路插管的患者危险因素暴露及尿路感染发病情况；以发生导管相关性尿路感染患者为病例组,未感染患者为对照组,应用logistic回归分析导管相关性尿路感染的危险因素。
4、分别采用SAS8.2和SPSS17.0软件构建医院感染Logistic回归和人工神经网络预测模型,以似然比检验、拟合优度检验和ROC曲线下面积评价模型预测效果。
5、采用方便抽样抽取国内121所三级、二级医院进行问卷调查,调查内容包括医院感染暴发组织框架、功能实现、运行程序和支撑系统等维度内容,对感染暴发应急处置现状进行分析并提出加强暴发应急的对策建议。
三、研究结果
1、2007年和2008年湖北省医院感染现患率均为3.61%,例次率分别为3.76%、3.84%。大学附属医院、ICU科、低年龄或高年龄组、男性患者医院感染患病率高,不同基础疾病患者医院感染患病率不相同或不全相同。感染部位以呼吸道最常见,其次为手术切口、泌尿道、胃肠道。医院感染病原体以革兰氏阴性细菌最常见,铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌和肺炎克雷伯菌居前五位。抗菌药物日使用率为52.49%。最常使用的抗菌药物依次为头孢菌素类、青霉素类和喹诺酮类。
2、湖北省ICU患者呼吸机相关性肺炎发病率为20.89%,发病密度为28.90/1000机械通气日。危险因素有：男性、昏迷、其他部位感染、慢性阻塞性肺病、严重基础疾病、支气管镜检查、气管造瘘术、使用抗酸药、使用抗菌药物超过4天。病原体以革兰氏阴性菌最为常见,铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌居前三位。铜绿假单胞菌对亚胺培南的耐药率为36.69%,对环丙沙星的耐药率为49.12%,鲍曼不动杆菌对亚胺培南的耐药率为64.97%,MRSA检出率为45.67%。
3、湖北省三级医院ICU患者导管相关性尿路感染发病率为20.52%,发病密度为33.05/1000尿路插管日。危险因素有：尿路插管时间≥7天、前列腺肥大、使用抗菌药物≥5天。最常见的病原体为白色念珠菌、肠球菌和大肠杆菌。
4、构建医院感染预测模型中,Logistic回归模型包含变量有：入住ICU天数、气管插管、前列腺肥大、动静脉插管、基础疾病为肿瘤等；构建的神经网络模型结构为{25-4-1},对感染结局影响最大的因素依次为ICU入住时间、抗菌药物使用情况、基础疾病诊断、年龄、使用插管等。经检验,Logistic回归模型和神经网络模型均有显著性意义,ROC曲线下面积分别为0.856和0.861。
5、医院在医院感染暴发应急处置能力和实际工作中,院感专职人员专业结构需要优化,人员专业素质需进一步改善,应急预案需及时修订并提高可及性,信息监测应进一步加强,病原微生物同源性检测能力严重不足,亟须提高。
四、研究结论
湖北省2007年与2008年的医院感染患病率总体平稳,均处于较低水平。湖北省ICU呼吸机相关性肺炎和导管相关性尿路感染发病显著高于发达国家水平,应针对感染的危险因素加强预防与控制措施。ICU患者医院感染Logistic回归预测模型和人工神经网络预测模型判别能力均很好,其中人工神经网络模型拟合效果更优。我国医院在应对医院感染暴发事件方面存在不足,应加强医院感染暴发应急能力建设,建立健全医院感染暴发预防控制工作体系。
五、创新点
采用多种研究方法系统研究了湖北省医院感染发生情况及影响因素,在国内首次采用大样本多中心队列研究对呼吸机相关性肺炎发病及影响因素进行研究,首次抽样调查分析了国内医疗机构医院感染暴发应急能力及工作现状,并提出对策和建议。
Objectives
The object of this study is to investigate the prevalence and risk factors of healthcare-associated infection (HCAI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) in Hubei Province, China, and to set up the HCAI forecast model of artificial neural networks (ANNs) and Logistic regression by the descriptive, analytical or theoretical epidemiologic methods. We also investigate the hospitals'ability and situation of prevention and control of the HCAI outbreak and make some proposals and advices.
Methods
1. The point prevalence surveys were carried out in 10 tertiary care hospitals in 2007 and 13 tertiary care hospitals in 2008 in Hubei Province, China. All patients in these hospitals who had been hospitalized on the day of the surveys were included. The following information was recorded for each patient:sex, age, current diagnoses, HCAI status, site of infection, results of microbiology culture, and whether the patient was on antibiotics. Medical records were reviewed for HCAI, using the definitions established by the Ministry of Health.
2. A multi-centre prospective cohort study was performed in 17 intensive care units (ICUs) in tertiary care hospitals in Hubei Province. All patients receiving mechanical ventilation (MV) who had been hospitalized in these ICUs for more than 48 h were included during the study period. Information on onset of VAP, micro-organisms associated with VAP, and potential risk factors for patients receiving MV were collected from medical and nursing records and recorded on a form. The univariate and multivariate logistic regression analyses were performed to identify risk factors for VAP.
3. The nested case-control study was conducted in an ICU in a tertiary care hospital in Hubei Province. All patients were selected from patients after urinary catheterization in the ICU. Individuals with urinary tract infection (UTI) served as cases, and the patients free of UTI as controls. A multivariable logistic regression model was performed to identify the independent risk factors for CAUTI.
4. Data of patients who had hospitalized in the ICU for more than 48h in a tertiary care hospital in Hubei Province were collected to construct the HCAI prediction model of ANNs and Logistic regressions. The prediction effects were evaluated by the Likelihood ratio test, Hosmer and Lemeshow goodness-of-fit test and the receive roperator characteristic curve.
5. Questionnaires were used to investigate the organizational framework, functional realization, program and support about the prevention and control of the HCAI outbreak in the conveniently sampled 121 hospitals in China. The data was analyzed and some proposals and advices were made.
Results
1. In total, the prevalence of HCAI in Hubei Province in 2007 and 2008 was 3.61%, with the frequency of HCAI being 3.76% in 2007 and 3.84% in 2008. Higher HCAI rates were found in patients from university hospitals, male patients, patients aged >55years or<10years, and in ICU patients compared with other groups. The HCAI rates differed among patients with different foundational diseases. Respiratory tract infection was the most common HCAI, followed by surgical site infection, urinary tract infection and gastrointestinal tract infection. Gram-negative bacteria were isolated most frequently and the most frequent organism was Pseudomonas aeruginose, followed by Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii and Klebsiella pneumoniae. Antibiotic use was documented for 52.49% patients, and cephalosporins, penicillins, and quinolones were the most commonly used agents for treatment or prophylaxis.
2. Among ventilated patients, the crude incidence rate and density of VAP were 20.89% and 28.90 cases per 1000 ventilator-days in Hubei Province. Multivariate analysis using logistic regression revealed risk factors, including male sex, coma, infections at other sites, chronic obstructive pulmonary disease, serious foundational disease, bronchoscopy, tracheostomy, use of antiacids, and the period of antimicrobial use >4 days. Gram-negative bacteria were isolated most frequently and the most frequently isolated causative pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Frequencies of imipenem-resistant P. aeruginosa, imipenem-resistant A. baumannii and Ciprofloxacin-resistant P. aeruginosa isolates were 36.69%,64.97% and 49.12% respectively. Of all Staphylococcus aureus isolates,45.67% were meticillin resistant.
3. Among patients, the incidence rate of CAUTI was 20.52%, and the density of infection was 33.05 per 1000 catheter-days in Hubei Province. By the multinomial logistic regression analysis, the CAUTI risk factors included the duration of catheterization (≥7 days), benign prostatic hypertrophy (BPH), and the duration of antimicrobial treatment (≥5 days). Of the isolates, fungi, especially Candida albicans, were isolated most frequently, followed by Escherichia coli and Pseudomonas aeruginosa.
4. The follow variables were factors of the HCAI prediction model of the logistic regression equation:the period of the patients in ICU, tracheal intubation, BPH, artery and venous cannula, age, tumor as the foundation disease, et al. The HCAI prediction model of ANNs was {25-4-1}, and the most important factors in this model are the period of the patients in ICU, use of antibacterials, age, the foundation diseases, use of catheters, et al. The areas under ROC (Receiver-operating characteristic curve) were 0.856 and 0.861 respectively.
5. There are some weaknesses in the organizational framework, functional realization, program and support about the prevention and control of the HCAI outbreak. The hospitals should strengthen the prevention and control of HCAI outbreak.
Conclusions The point prevalences of HCAI in tertiary care hospitals in 2007 and 2008 in Hubei Province were steady and at relative low level. The incidence rates of VAP and CAUTI among patients in Hubei Province were higher than those of the developed countries, and the prevention and control of HCAI should be strengthened to improve the situation. The model of ANNs was better than the logistic regression in predicting the HCAI among ICU patients. There're some weaknesses in the prevention and control of the HCAI outbreak in Chinese hospials. To prevent and control HCAI outbreak effectively, the sanitation stringency should be constructed and perfected in these hospitals.
Innovation
The study systematically investigated the prevalence and risk factors of HCAI among patients in Hubei Province. It's the first time in China to perform a multi-centre prospective cohort study of VAP, and to use questionnaires to investigate the prevention and control of the HCAI outbreak in hospitals and then to make some proposals.
本研究旨在利用描述性、分析性和理论流行病学研究方法,调查湖北省医院感染患病情况及影响因素、呼吸机相关性肺炎和导管相关性尿路感染发病及危险因素,构建医院感染预测模型,抽样调查全国部分省市医疗机构医院感染暴发应急现状并提出对策和建议。
二、研究方法
1、抽样调查湖北省三级甲等医院住院患者医院感染患病情况。调查采用统一方法进行,收集调查日当天所有住院患者信息,包括性别、年龄、当前诊断、医院感染和微生物培养结果、抗菌药物使用情况等。医院感染诊断标准采用卫生部2001年《医院感染诊断标准(试行)》。
2、在湖北省17所三级甲等医院ICU中开展呼吸机相关性肺炎多中心前瞻性队列研究,随访入住ICU超过48小时且接受机械通气的患者呼吸机相关性肺炎的发病及危险因素暴露情况。应用logistic回归分析呼吸机相关性肺炎危险因素。
3、在湖北省某三级甲等医院入住ICU且接受尿路插管的患者中开展巢式病例对照研究,随访接受尿路插管的患者危险因素暴露及尿路感染发病情况；以发生导管相关性尿路感染患者为病例组,未感染患者为对照组,应用logistic回归分析导管相关性尿路感染的危险因素。
4、分别采用SAS8.2和SPSS17.0软件构建医院感染Logistic回归和人工神经网络预测模型,以似然比检验、拟合优度检验和ROC曲线下面积评价模型预测效果。
5、采用方便抽样抽取国内121所三级、二级医院进行问卷调查,调查内容包括医院感染暴发组织框架、功能实现、运行程序和支撑系统等维度内容,对感染暴发应急处置现状进行分析并提出加强暴发应急的对策建议。
三、研究结果
1、2007年和2008年湖北省医院感染现患率均为3.61%,例次率分别为3.76%、3.84%。大学附属医院、ICU科、低年龄或高年龄组、男性患者医院感染患病率高,不同基础疾病患者医院感染患病率不相同或不全相同。感染部位以呼吸道最常见,其次为手术切口、泌尿道、胃肠道。医院感染病原体以革兰氏阴性细菌最常见,铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌和肺炎克雷伯菌居前五位。抗菌药物日使用率为52.49%。最常使用的抗菌药物依次为头孢菌素类、青霉素类和喹诺酮类。
2、湖北省ICU患者呼吸机相关性肺炎发病率为20.89%,发病密度为28.90/1000机械通气日。危险因素有：男性、昏迷、其他部位感染、慢性阻塞性肺病、严重基础疾病、支气管镜检查、气管造瘘术、使用抗酸药、使用抗菌药物超过4天。病原体以革兰氏阴性菌最为常见,铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌居前三位。铜绿假单胞菌对亚胺培南的耐药率为36.69%,对环丙沙星的耐药率为49.12%,鲍曼不动杆菌对亚胺培南的耐药率为64.97%,MRSA检出率为45.67%。
3、湖北省三级医院ICU患者导管相关性尿路感染发病率为20.52%,发病密度为33.05/1000尿路插管日。危险因素有：尿路插管时间≥7天、前列腺肥大、使用抗菌药物≥5天。最常见的病原体为白色念珠菌、肠球菌和大肠杆菌。
4、构建医院感染预测模型中,Logistic回归模型包含变量有：入住ICU天数、气管插管、前列腺肥大、动静脉插管、基础疾病为肿瘤等；构建的神经网络模型结构为{25-4-1},对感染结局影响最大的因素依次为ICU入住时间、抗菌药物使用情况、基础疾病诊断、年龄、使用插管等。经检验,Logistic回归模型和神经网络模型均有显著性意义,ROC曲线下面积分别为0.856和0.861。
5、医院在医院感染暴发应急处置能力和实际工作中,院感专职人员专业结构需要优化,人员专业素质需进一步改善,应急预案需及时修订并提高可及性,信息监测应进一步加强,病原微生物同源性检测能力严重不足,亟须提高。
四、研究结论
湖北省2007年与2008年的医院感染患病率总体平稳,均处于较低水平。湖北省ICU呼吸机相关性肺炎和导管相关性尿路感染发病显著高于发达国家水平,应针对感染的危险因素加强预防与控制措施。ICU患者医院感染Logistic回归预测模型和人工神经网络预测模型判别能力均很好,其中人工神经网络模型拟合效果更优。我国医院在应对医院感染暴发事件方面存在不足,应加强医院感染暴发应急能力建设,建立健全医院感染暴发预防控制工作体系。
五、创新点
采用多种研究方法系统研究了湖北省医院感染发生情况及影响因素,在国内首次采用大样本多中心队列研究对呼吸机相关性肺炎发病及影响因素进行研究,首次抽样调查分析了国内医疗机构医院感染暴发应急能力及工作现状,并提出对策和建议。
Objectives
The object of this study is to investigate the prevalence and risk factors of healthcare-associated infection (HCAI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) in Hubei Province, China, and to set up the HCAI forecast model of artificial neural networks (ANNs) and Logistic regression by the descriptive, analytical or theoretical epidemiologic methods. We also investigate the hospitals'ability and situation of prevention and control of the HCAI outbreak and make some proposals and advices.
Methods
1. The point prevalence surveys were carried out in 10 tertiary care hospitals in 2007 and 13 tertiary care hospitals in 2008 in Hubei Province, China. All patients in these hospitals who had been hospitalized on the day of the surveys were included. The following information was recorded for each patient:sex, age, current diagnoses, HCAI status, site of infection, results of microbiology culture, and whether the patient was on antibiotics. Medical records were reviewed for HCAI, using the definitions established by the Ministry of Health.
2. A multi-centre prospective cohort study was performed in 17 intensive care units (ICUs) in tertiary care hospitals in Hubei Province. All patients receiving mechanical ventilation (MV) who had been hospitalized in these ICUs for more than 48 h were included during the study period. Information on onset of VAP, micro-organisms associated with VAP, and potential risk factors for patients receiving MV were collected from medical and nursing records and recorded on a form. The univariate and multivariate logistic regression analyses were performed to identify risk factors for VAP.
3. The nested case-control study was conducted in an ICU in a tertiary care hospital in Hubei Province. All patients were selected from patients after urinary catheterization in the ICU. Individuals with urinary tract infection (UTI) served as cases, and the patients free of UTI as controls. A multivariable logistic regression model was performed to identify the independent risk factors for CAUTI.
4. Data of patients who had hospitalized in the ICU for more than 48h in a tertiary care hospital in Hubei Province were collected to construct the HCAI prediction model of ANNs and Logistic regressions. The prediction effects were evaluated by the Likelihood ratio test, Hosmer and Lemeshow goodness-of-fit test and the receive roperator characteristic curve.
5. Questionnaires were used to investigate the organizational framework, functional realization, program and support about the prevention and control of the HCAI outbreak in the conveniently sampled 121 hospitals in China. The data was analyzed and some proposals and advices were made.
Results
1. In total, the prevalence of HCAI in Hubei Province in 2007 and 2008 was 3.61%, with the frequency of HCAI being 3.76% in 2007 and 3.84% in 2008. Higher HCAI rates were found in patients from university hospitals, male patients, patients aged >55years or<10years, and in ICU patients compared with other groups. The HCAI rates differed among patients with different foundational diseases. Respiratory tract infection was the most common HCAI, followed by surgical site infection, urinary tract infection and gastrointestinal tract infection. Gram-negative bacteria were isolated most frequently and the most frequent organism was Pseudomonas aeruginose, followed by Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii and Klebsiella pneumoniae. Antibiotic use was documented for 52.49% patients, and cephalosporins, penicillins, and quinolones were the most commonly used agents for treatment or prophylaxis.
2. Among ventilated patients, the crude incidence rate and density of VAP were 20.89% and 28.90 cases per 1000 ventilator-days in Hubei Province. Multivariate analysis using logistic regression revealed risk factors, including male sex, coma, infections at other sites, chronic obstructive pulmonary disease, serious foundational disease, bronchoscopy, tracheostomy, use of antiacids, and the period of antimicrobial use >4 days. Gram-negative bacteria were isolated most frequently and the most frequently isolated causative pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus. Frequencies of imipenem-resistant P. aeruginosa, imipenem-resistant A. baumannii and Ciprofloxacin-resistant P. aeruginosa isolates were 36.69%,64.97% and 49.12% respectively. Of all Staphylococcus aureus isolates,45.67% were meticillin resistant.
3. Among patients, the incidence rate of CAUTI was 20.52%, and the density of infection was 33.05 per 1000 catheter-days in Hubei Province. By the multinomial logistic regression analysis, the CAUTI risk factors included the duration of catheterization (≥7 days), benign prostatic hypertrophy (BPH), and the duration of antimicrobial treatment (≥5 days). Of the isolates, fungi, especially Candida albicans, were isolated most frequently, followed by Escherichia coli and Pseudomonas aeruginosa.
4. The follow variables were factors of the HCAI prediction model of the logistic regression equation:the period of the patients in ICU, tracheal intubation, BPH, artery and venous cannula, age, tumor as the foundation disease, et al. The HCAI prediction model of ANNs was {25-4-1}, and the most important factors in this model are the period of the patients in ICU, use of antibacterials, age, the foundation diseases, use of catheters, et al. The areas under ROC (Receiver-operating characteristic curve) were 0.856 and 0.861 respectively.
5. There are some weaknesses in the organizational framework, functional realization, program and support about the prevention and control of the HCAI outbreak. The hospitals should strengthen the prevention and control of HCAI outbreak.
Conclusions The point prevalences of HCAI in tertiary care hospitals in 2007 and 2008 in Hubei Province were steady and at relative low level. The incidence rates of VAP and CAUTI among patients in Hubei Province were higher than those of the developed countries, and the prevention and control of HCAI should be strengthened to improve the situation. The model of ANNs was better than the logistic regression in predicting the HCAI among ICU patients. There're some weaknesses in the prevention and control of the HCAI outbreak in Chinese hospials. To prevent and control HCAI outbreak effectively, the sanitation stringency should be constructed and perfected in these hospitals.
Innovation
The study systematically investigated the prevalence and risk factors of HCAI among patients in Hubei Province. It's the first time in China to perform a multi-centre prospective cohort study of VAP, and to use questionnaires to investigate the prevention and control of the HCAI outbreak in hospitals and then to make some proposals.
引文
[1]Burke JP. Infection control—a problem for patient safety[J]. N Engl J Med 2003; 348:651-656.
[2]Haley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals[J]. Am J Epidemiol 1985; 121:182-205.
[3]朱士俊,郭燕红,李六亿,等.医院感染管理工作现状与展望[J].中国医院.2007,11(1)：6-9.
[4]黄勋,吴安华,徐秀华.医院安全与医院感染刍议[J].中国护理管理.2005,5(1)：12-14.
[5]Cauet D, Quenon JL, Desve G. Surveillance of hospital acquired infections: presentation of a computerised system[J]. Eur J Epidemiol 1999; 15:149-153.
[6]Sanchez-Paya J, Bischofberger C, Lizan M, et al. Nosocomial infection surveillance and control:current situation in Spanish hospitals[J]. J Hosp Infect 2009; 72:50-56.
[7]Gikas A, Pediaditisy J, Papadakis JA, et al. Prevalence study of hospital-acquired infections in 14 Greek hospitals:planning from the local to the national surveillance level[J]. J Hosp Infect 2002; 50:269-275.
[8]Hopmans TEM, Blok HEM, Troelstra A, Bonten MJM. Prevalence of hospital-acquired infections during successive surveillance surveys conducted at a university hospital in The Netherlands [J]. Infect Control Hosp Epidemiol 2007; 28:459-465.
[9]任南,文细毛,吴安华.全国医院感染横断面调查结果的变化趋势研究[J].中国感染控制杂志,2007,6(1)：16-18.
[10]任南,文细毛,吴安华,徐秀华,易霞云,巩玉秀.178所医院医院感染危险因素调查分析[J].中国感染控制杂志,2003,2(1)：6-10.
[11]Gastmeier P,Balderjahn SS,Hansen S,et al.How outbreaks Can contribute to prevention ofnosocomial infection:Analysis of 1022 outbreaks[J]. Infect Control Hosp Epidemiol.2005; 26(4):357-362.
[12]王红梅,索瑶,李金娜,等.典型医院感染事件分析及对策[J].现代预防医学,2010,37(20)：3994-3997.
[13]裴霞.医院感染的横断面调查与分析[J].中华疾病控制杂志,2010,14(8)：810-811.
[14]马文晖,王力红,张京利,等.连续3年医院感染现患率调查分析[J].中华医院感染学杂志,20(1)：23-25.
[15]Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections,1988[J]. Am J Infect Control 1988; 16:128-140.
[16]Wilsonl APR, Hodgsonl B, Liu M, et al. Reduction in wound infection rates by wound surveillance with postdischarge follow-up and feedback[J]. Brit J Surg 2006; 93:630-638.
[17]Barwolff S, Sohr D, Geffers C, et al. Reduction of surgical site infections after caesarean delivery using surveillance [J]. J Hosp Infect 2006; 64:156-161.
[18]Berthelot P, Gamier M, Fascia P, et al. Conversion of prevalence survey data on nosocomial infections to incidence estimates:a simplified tool for surveillance? [J]. Infect Control Hosp Epidemiol 2007; 28:633-636.
[19]Morton AP, Clements ACA, Doidge SR, Stackelroth J, Curtis M, Whitby M. Surveillance of healthcare-acquired infections in queensland, australia:data 695-701. and lessons from the first 5 years [J]. Infect Control Hosp Epidemiol 2008; 29:
[20]Lanini S, Jarvis WR, Nicastri E, et al. Healthcare-associated infection in Italy: annual point-prevalence surveys,2002-2004[J]. Infect Control Hosp Epidemiol 2009; 30:659-665.
[21]Eriksen HM, IversenBG, Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway,2002 and 2003 [J]. J Hosp Infect 2005; 60:40-45.
[22]王悦,张鲁涛,史利克,等.1483例住院患者医院感染横断面调查及分析[J].中华医院感染学杂志.2010,20(17)：2566-2569.
[23]张晓卿.医院感染现患率调查情况与分析[J].现代预防医学,2010,37(13)：2461-2466.
[24]任南,文细毛,吴安华.2008年全国医院感染横断面调查报告[J].中国医院协会第十六届医院感染管理学术年会论文集,2009：396-399.
[25]Faria S, Sodano L, Gjata A, et al. The first prevalence survey of nosocomial infections in the University Hospital Centre'Mother Teresa' of Tirana, Albania[J]. J Hosp Infec 2007; 65:244-250.
[26]Selma M, Yurdanur A, Gul D, Cemalettin K. Prevalence and characteristics of nosocomial infections in a Turkish university hospital[J]. AJIC 2004; 20: 409-413.
[27]Gastmeier P. European perspective on surveillance [J]. J Hosp Infect 2007; 65(S2):159-164.
[28]Perencevich EN, McGregor JC, Shardell M, et al. Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients[J]. Infect Control Hosp Epidemiol 2008; 29:1124-1131.
[29]Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ET. The Second National Prevalence Survey of infection in hospitals—overview of the results [J]. J Hosp Infect.1996; 32:175-190.
[30]Bergogne, Berezin E. Current guidelines for the treatment and prevention of nosocomial infections [J]. Drugs 1999; 58:51-67.
[31]任南,文细毛,吴安华,李洁,徐秀华.教学医院与非教学医院的医院感染比较研究[J].中华医院感染学杂志,2004,14(3)：261-264.
[32]Wang A, Fan S, Yang Y, Shen X. Nosocomial infections among pediatric hematology patients:results of a retrospective incidence study at a pediatric hospital in China[J]. J Pediatr Hematol Oncol 2008; 30:674-678.
[33]Eggimann P, Pittet D. Infection control in the ICU. Chest 2001; 120:2059-2093.
[34]A report from the NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004[J]. Am J Infect Control 2004; 32:470-485.
[35]Ansari F, Erntell M, Goossens H, Davey P. The European Surveillance of Antimicrobial Consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006[J]. Clin Infect Dis 2009; 49:1496-1504.
[36]文细毛,任南,吴安华等.全国医院感染监控网细菌耐药情况及变化趋势[J].中国感染控制杂志,2009,8(6)：389-408.
[37]Xie DS, Xiong W, Xiang LL, et al. Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China,2007-2008[J]. J Hosp Infect 2010; 76:150-155.
[38]Chastre J, Fagon JY. Ventilator-associated pneumonia[J]. Am J Respir Crit Care Med 2002; 165:867-903.
[39]Cavalcanti M, Valencia M, Torres A. Respiratory nosocomial infections in the medical intensive care unit[J]. Microbes Infect 2005; 7:292-301.
[40]Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia:A systematic review[J]. Crit Care Med 2005; 33:2184-93.
[41]Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient[J]. Am J Respir Crit Care Med 1999; 159:1249-56.
[42]Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group. Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database[J]. Chest 2002; 122:2115-21.
[43]Marik PE. An evidence-based approach to the diagnosis of ventilator-associated pneumonia[J]. Respir Care 2009; 54:1453-61.
[44]Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:incidence and risk factors [J]. J Infect Dev Ctries 2009; 3:771-7.
[45]Edwards JR, Peterson KD, Andrus ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007[J]. Am J Infect Control 2007; 35:290-301.
[46]Meyer E, D. Sohr, Gastmeier P, Geffers C. New identification of outliers and ventilator associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System[J]. J of Hosp Infect 2009; 73: 246-52.
[47]Blamoun J, Alfakir M, Rella ME, et al. Efficacy of an expanded ventilator bundle for the reduction of ventilatorassociated pneumonia in the medical intensive care unit[J]. Am J Infect Control 2009; 37:172-5.
[48]Al-Tawfiq JA, Abed MS. Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle [J]. Am J Infect Control 2010; 38:552-6.
[49]孙铁英,李燕明,胡云建,等.呼吸机相关性肺炎临床资料和危险因素的回顾分析[J].中华内科杂志,2002,41(7)：468-471.
[50]金浩承,何礼贤.呼吸机相关性肺炎的病原学诊断技术与临床意义[J].中国呼吸与危重监护杂志,2004,3(5)：329-331.
[51]Moreno CA, Rosenthal VD, Olarte N, et al. Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals:Findings of the International Nosocomial Infection Control Consortium [J]. Infect Control Hosp Epidemiol 2006; 27:349-56.
[52]Tejerina E, Frutos-Vivar F, I.Restrepo M, et al.Incidence, risk factors, and outcome of ventilator-associated pneumonia[J]. J Crit Care 2006; 21:56-65.
[53]Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing:16th information supplement[M] M100-S18. Wayne, PA.2006.
[54]Giard M, Lepape A, Allaouchiche B, et al. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit:comparison of risk factors[J]. J Crit Care 2008; 23:27-33.
[55]Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco:Findings of the International Nosocomial Infection Control Consortium (INICC) [J]. Int Arch Med 2009,2:29-36.
[56]Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries:a systematic review[J]. Int J of Infect Dis 2008; 12:505-12.
[57]李华茵,何礼贤,胡必杰,等.重症监护病房呼吸机相关肺炎临床与病原学分析[J].中国呼吸与危重监护杂志,2006,4(4)：266-270.
[58]徐炎,张乐嘉,戈海廷,等.新生儿重症监护病房的院内感染638例分析[J].中华儿科杂志,2007,45(6)：437-441.
[59]Razaa MW, Kazib BM, Mustafac M, Gould FK. Developing countries have their own characteristic problems with infection control[J]. J Hosp Infect 2004; 57: 294-9.
[60]Napolitano LM. Use of Severity Scoring and Stratification Factors in Clinical Trials of Hospital-Acquired and Ventilator-Associated Pneumonia[J]. Clin Infect Dis 2010; 51:S67-80.
[61]张永利,范姝文,万献尧.重症监护病房中呼吸机相关性肺炎相关因素分析[J].中国医师杂志,2006,8(3)：380-381.
[62]张亚莉,耿穗娜,汪能平,等.呼吸机相关性肺炎临床与病原菌特点分析[J].中华医院感染学杂志,2006,16(4)：453-456.
[63]Kollef MH. Prevention of hospital-associated pneumonia and ventilator- associated pneumonia[J]. Crit Care Med 2004; 32:1396-405.
[64]黄苒.重症监护病房发生呼吸机相关性肺炎的病原菌分析及护理[J].中国医学工程,2010,18(2)：105-106.
[65]张玉莲,何小静,郭剑,等.气管切开术后呼吸道病原菌分布及相关因素研究[J].中华医院感染学杂志,2009,19(10)：1296-1298.
[66]Medina J, Formento C, Pontet J, et al. Prospective study of risk factors for ventilator-associated pneumonia caused by Acinetobacter species[J].J Crit Care 2007,22:18-26.
[67]Lagamayo EN. Antimicrobial resistance in major pathogens of hospital-acquired pneumonia in Asian countries[J]. Am J Infect Control 2008; 36:S101-8.
[68]Suetens C, Morales I, Savey A, et al. European surveillance of ICU-acquired infections (HELICS-ICU):methods and main results[J]. J Hosp Infect 2007; 65: 171-3.
[69]Lizioli A, Privitera G, Alliata E, et al. Prevalence of nosocomial infections in Italy:result from the Lombardy survey in 2000[J]. J Hosp Infect 2003; 54: 141-8.
[70]Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study[J]. JAMA 1995; 274:639-44.
[71]Erben N, Alpat SN, Kartal ED. Analysis of the risk factors in nosocomial urinary tract infections and effect of urinary catheter use on distribution of the causative agents [J]. Mikrobiyol Bul 2009; 43:77-82.
[72]Rosenthal VD, Maki DG, Jamulitrat S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009 [J]. Am J Infect Control 2010; 38:95-106.
[73]Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria[J]. Am J Infect Control 2000; 28:68-75.
[74]Edwards JR, MStat, Peterson KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008[J]. Am J Infect Control 2008; 36:609-26.
[75]Zolldann D, Thiex R, Hafner H, et al. Periodic surveillance of nosocomial infections in a neurosurgery intensive care unit[J]. Infect 2005; 33:115-21.
[76]Talaat M, Hafez S, Saied T. Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt [J]. Am J Infect Control 2010; 38:222-8.
[77]Rosenthal VD, Guzman RN, Crnich C. Device-associated nosocomial infection rates in intensive care units of Argentina[J]. Infect Control Hosp Epidemiol 2004; 25:251-5.
[78]Rothfeld AF, Stickley A. A program to limit urinary catheter use at an acute care hospital[J]. Am J Infect Control 2010; 4:1-4.
[79]陈红花.导尿管相关尿路感染危险因素调查分析[J].中华医院感染学杂志,2008,18(9)：1276-1278.
[80]Saint S, Lipsky BA. Preventing catheter-related bacteriuria:should we? Can we? How? [J]. Arch Intern Med 1999; 159:800-8.
[81]Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters[J]. Emerg Infect Dis 2001; 7:342-7.
[82]Wyndaele JJ. Complications of intermittent catheterization:their prevention and treatment[J]. Spinal Cord 2002; 40:536-41.
[83]Storfer SP, Medoff G, Fraser VJ, Powderly WG, Dunagan WC.Candiduria: retrospective review in hospitalized patients [J]. Infect Dis Clin Pract 1994; 3:23-9.
[84]Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients [J]. Clin Infect Dis 2000; 30:14-8.
[85]Kallas HE, Chintanadilok J, Maruenda J. Treatment of nocturia in the elderly [J]. Drugs Aging.1999; 15:429-37.
[86]Mojtahedzadeh M, Panahi Y, Fazeli MR, et al. Intensive care unit-acquired urinary tract infections in patients admitted with sepsis:etiology, risk factors, and patterns of antimicrobial resistance [J]. Int J Infect Dis 2008; 12:312-8.
[87]Laupland KB, Bagshaw SM, Gregson DB, Kirkpatrick AW, Ross T, Church DL. Intensive care unit-acquired urinary tract infections in a regional critical care system[J]. Crit Care 2005; 9:R60-5.
[88]Rosser CJ, Bare RL, Meredith JW. Urinary tract infections in the critically ill patient with a urinary catheter [J]. Am JSurg 1999; 177:287-90.
[89]马晓波,吕晓菊,过孝静,等.5771份尿培养结果分析及药敏监测[J].四川大学学报,2007,38(4)：745-747.
[90]Alvarez-Lerma F, Nolla-Salas J, Leon C, et al. Candiduria in critically ill patients admitted to intensive care medical units [J]. Intens Care Med 2003; 29:1069-76.
[91]Gubbins PO, Piscitelli SC, DanzigerLH. Candidal urinay tract infections:a comprehensive review of their diagnosis and management [J]. Pharmacotherapy 1993; 13:110-27.
[92]Leone M, Albanese J, Gamier F, et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit [J]. Intens Care Med 2003; 29:1077-80.
[93]叶海云,侯树坤,曲星珂,等.细菌生物膜对尿管相关性尿路感染的影响[J].中华泌尿外科杂志,2006,27(2)：135-138.
[94]Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults:2009 international clinical practice guidelines from the infectious diseases society of America[J]. Clin Infect Dis 2010; 50:625-63.
[95]施金芬,王建荣,马燕兰.重危患者留置尿管表面生物被膜形成的观察[J].解放军护理杂志,2009,26(4B)：10-16.
[96]Gardam MA, Amihod B, Orenstein P, Consolacion N, Miller MA. Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections[J]. Clin Perform Qual Health Care 1998; 6:99-102.
[97]Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients[J]. Arch Intern Med 1995; 155:1425-9.
[98]Elpern EH, Killeen K, Ketchem A, Wiley A, Patel G, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections [J]. Am J Crit Care 2009; 18:535-41.
[99]牛家兰.留置导尿患者预防尿路感染的护理进展[J].安徽医学,2010,31(7)：52-853.
[100]王力红,赵霞,张京利,杨淼,马文晖.重症监护病房医院感染预警模型的建立[J].中华医院感染学杂志,2010,20(21)：3368-3370.
[101]罗阳,丁国英,府伟灵,等.季节性时间序列分析在医院感染中的应用[J].中华医院感染学杂志2005,15(4)：390-392.
[102]许林勇,白毅,胡明,等.基于人工神经网络模型的医院感染危险度预测[J].中南大学学报(医学版)2006,31(3)：404-407.
[103]姜天俊,闫子国,赵敏,等.晚期肝病患者并发真菌感染的早期预警指标研究[J].临床肝胆病杂志2007,(23)：362-364.
[104]El-Solh AA, Hsiao CB, Goodnough S, Serghani J, Grant BJ. Predicting active pulmonary tuberculosis using an artificial neural network[J]. Chest.1999, 116(4):968-73.
[105]Lammers RL, Hudson DL, Seaman ME. Prediction of traumatic wound infection with a neural network-derived decision model[J]. Am J Emerg Med. 2003,21(1):1-7.
[106]Dybowski R, Weller P, Chang R, Gant V. Prediction of outcome in critically ill patients using artificial neural network synthesised by genetic algorithm [J]. Lancet.1996; 347(9009):1146-50.
[107]Eftekhar B, Mohammad K, Ardebili HE, Ghodsi M, Ketabchi E. Comparison of artificial neural network and logistic regression models for prediction of mortality in head trauma based on initial clinical data[J]. BMC Med Inform Decis Mak.2005; 5:3.
[108]Wang CH, Mo LR, Lin RC, Kuo JJ, Chang KK, Wu JJ. Artificial neural network model is superior to logistic regression model in predicting treatment outcomes of interferon-based combination therapy in patients with chronic hepatitis C[J]. Intervirology.2008,51(1):14-20.
[109]张京利,赵霞,王力红,马文晖,王桂珍.重症监护病房患者医疗干预措施与医院感染的相关性研究[J].中华医院感染学杂志,2010,20(2)：187-189.
[110]许林勇,张延霞,田晓丽,漆冰,等.医院感染危险度的预测预报[J].中国医师杂志,2004,6(2)：165-167.
[111]Natalie M. Spearing,etl. Direct costs associated with a nosocomial outbreak of Salmonella infection:An ounce of prevention is worth a pound of cure[J]. Association for Professionals in Infection Control and Epidemiology,2000, 28(1):54-57.
[112]Utsumi M., Makimoto K., Quroshi N., Ashida N. Types of infectious outbreaks and their impact in elderly care facilities:a review of the literature [J]. Age and Ageing 2010; 39:299-305.
[113]Petra Gastmeier, Sabine Stamm-Balderjahn, Sonja Hansen,et tl. How outbreaks can contribute to prevention of nosocomial infection:analysis of 1,022 outbreaks[J]. Infect Control Hosp Epidemiol,2005,26(4):357-361.
[114]徐秀华.临床医院感染学[M]长沙：湖南科学技术出版社,2005,65.
[115]Gastmeier P., Loui A., Stamm-Balderjahn S, et al. Outbreaks in neonatal intensive care units— They are not like others[J]. AJIC,2007; 35:172-6.
[116]V Rabier, S Bataillon, A Jolivet-Gougeon,et al. Hand washing soap as a source of neonatal Serratia marcescens outbreak[J]. Acta Pcediatrica,2008,1381-1385.
[117]Carlos Sanchez-Carrillo, PharmD,Bele'n Padilla, MD, Mercedes Marin, Phd,et al. Contaminated feeding bottles:The source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit[J]. AJIC,2009,37(2): 150-154.
[118]Nehad Nasef, Karel O'Brien, Lesley Wylie,etl.Leesesarscho anrticsle from SARS:A retrospective study of outpatient care during an infectious disease outbreak[J].BMC Pediatrics,2010,1-6.
[119]SARS Investigation Team from DMERI,and SGH. Strategies adopted and lessons learnt during the severe acute respiratory syndrome crisis in Singapore[J]. Wiley InerScience,2004,15:57-70.
[120]曾光SARS危机与中国公共卫生的进步[J].安徽预防医学杂志,2007,13(4)：241-244.
[121]邱泽青.浅谈我国突发公共卫生事件应急预案体系的构成与管理[J].现代预防医学,2008,35(12)：2350-2355.
[122]舒明蓉,李大江,王星月,等.如何提高医院感染监测系统灵敏度和特异度[J].现代预防医学,2007,34(9)：1776-1778.
[123]朱宏,孙树梅,陈莉雅,等.医院感染暴发的监测与预警[J].南方医科大学学报,2008,28(8)：1458-1462.
[124]Alina Filozov, Paul Visintainer, Carol Carbonaro, et al. Epidemiology of an outbreak of antibiotic-resistant Klebsiella pneumoniae at a tertiary care medical center[J]. AJIC,2009,37(9):723-728.
[125]乔甫,康梅,谭成,等PFGE在识别和追踪医院感染暴发及流行中的应用[J].现代预防医学,2007,34(14)：2660-2663.
[126]张国荣,钟初雷,陈文光.医院感染预警系统的建立与应用[J].中华医院感染学杂志,2007,17(2)：176-178.
[127]王力红,张京利,马文晖,等.从医院感染暴发谈医疗机构危机管理[J].中国医院,2008,12(8)：36-38.
[128]黄伟灿,吕世伟,李堂林.试论我国公共卫生应急体系的构建[J].中华医院管理杂志,2003,19(10)：577-579.
[129]赵琦,赵根明,韦建国,等.突发公共卫生事件应急体系建设内涵[J].中国公共卫生管理,2008,24(5)：477-479.
[1]Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient[J]. Am J Respir Crit Care Med 1999; 159: 1249-1256.
[2]Chastre J, Fagon JY. Ventilator-associated pneumonia [J].Am J Respir Crit Care Med 2002; 165:867-903.
[3]Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review [J]. Crit Care Med.2005,33(10),2184-2193.
[4]Beyersmann J, Gastmeier P, Grundmann H, et al. Use of multistate models to assess prolongation of intensivecare unit stay due to nosocomial infection[J]. Infec Control Hosp Epidemiol.2006,27(5),493-499.
[5]Morris AC, Kefala K, Simpson AJ, et al. Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia [J]. Thorax 2009,64(6),516-522.
[6]Richards MJ,Edwards JR,Culver DH,Gaynes RP.Nosocomial infections in medical intensive care units in the United States.National Nosocomial Infections Surveillance System [J]. Crit Care Med 1999; 27:887-92.
[7]Kollef MH.What is ventilator-associated pneumonia and why is it important? [J]. Respir Care 2005; 50:714-21.
[8]Edwards JR, Peterson KD, Andrus ML, et al National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007[J]. Am J Infect Control 2007; 35:290-301.
[9]Meyer E, D. Sohr, Gastmeier P, Geffers C. New identification of outliers and ventilator associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System [J]. J of Hosp Infect 2009; 73:246-52.
[10]Giard M, Lepape A, Allaouchiche B, et al. Early-and late-onset ventilator-associated pneumonia acquired in the intensive care unit:comparison of risk factors[J]. J Crit Care 2008; 23:27-33.
[11]Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:incidence and risk factors [J]. J Infect Dev Ctries 2009; 3:771-7.
[12]Moreno CA, Rosenthal VD, Olarte N, et al. Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium [J]. Infect Control Hosp Epidemiol 2006; 27:349-56.
[13]Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco:Findings of the International Nosocomial Infection Control Consortium (INICC) [J]. Int Arch Med 2009, 2:29-36.
[14]Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries:a systematic review [J]. Int J of Infect Dis 2008; 12:505-12.
[15]金浩承,何礼贤.呼吸机相关性肺炎的病原学诊断技术与临床意义[J].中国呼吸与危重监护杂志,2004,3(5)：329-331.
[16]Rello J, Quintana E, Ausina V et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients [J]. Chest 1991, 100(2),439-444.
[17]Tejerina E, Frutos-Vivar F, Restrepo MI et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia [J]. J. Crit. Care.2006,21(1), 56-65.
[18]Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units [J]. JAMA 1996,275(11),866-869.
[19]倪菊平,倪金迪,余跃天,王成碧,刘春艳.呼吸机相关性肺炎的危险因素及病原学研究[J].内科急危重症杂志,2010,16(3)：143-147.
[20]Nguile-Makao M, Zahar JR, Francais A et al. Attributable mortality of ventilatorassociated pneumonia:respective impact of main characteristics at icu admission and vap onset using conditional logistic regression and multi-state models[J]. Intensive Care Med.2010,36(5),781-789.
[21]Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system [J]. J. Crit. Care, 2008,23(1):5-10.
[22]Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database [J]. Chest 2002; 122: 2115-21.
[23]Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit:a case-control study [J]. BMC Pulm Med 2004; 4:3.
[24]Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia:its relevance to developing effective strategies for prevention [J]. Respir Care,2005,50:725-39.
[25]孙耕耘.关注吸入性肺炎的防治.临床肺科杂志,2008,13(7)：819-820.
[26]Ewig S, Torres A, El-Ebiary M, et al. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia [J]. Am J Respir Crit Care Med 1999; 159:188-98.
[27]Bergmans DC, Bonten MJ, van Tiel FH, et al. Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit [J]. Thorax 1998;53:1053-8.
[28]Torres A, El-Ebiary M, Soler N, Monton C, Fabregas N, Hernandez C. Stomach as a source of colonization of the respiratory tract during mechanical ventilation:association with ventilator-associated pneumonia [J]. Eur Respir J 1996; 9:1729-35.
[29]Koenig SM, Truwit JD. Ventilator-associated pneumonia:diagnosis, treatment, and prevention [J]. Clin Microbiol Rev 2006; 19:637-57.
[30]Park DR. The microbiology of ventilator-associated pneumonia [J]. Respir Care 2005; 50:742-63.
[31]Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:role of multi-drug resistant pathogens [J]. J Infect Dev Ctries 2010; 4:218-25.
[32]孙铁英,李燕明,胡云建,明树红.呼吸机相关性肺炎临床资料和危险因素的回顾分析[J].中华内科杂志,2002,41(7)：468-471.
[33]Craven DE. Epidemiology of ventilator-associated pneumonia [J]. Chest, 2000; 117:186S-7S.
[34]Niederman MS, Craven DE. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia [J]. Am J Respir Crit Care Med,2005; 171:388-416.
[35]Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii [J]. Antimicrob Agents Chemother 2007; 51:3471-84.
[36]Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat [J]. Clin Microbiol Rev 2001; 14:933-51.
[37]Torres A, Carlet J. Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia [J]. Eur Respir J 2001; 17:1034-45.
[38]Combes A, Figliolini C, Trouillet JL, et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia [J]. Chest 2002; 121: 1618-23.
[39]Marquette CH, Copin MC, Wallet F, et al. Diagnostic tests for pneumonia in ventilated patients:prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard [J]. Am J Respir Crit Care Med 1995; 151:1878-88.
[40]Rouby JJ, Martin DL, Poete P, et al. Nosocomial bronchopneumonia in the critically ill. Histologic and bacteriologic aspects [J]. Am Rev Respir Dis 1992; 146:1059-66.
[41]Kirtland SH, Corley DE, Winterbauer RH, et al. The diagnosis of ventilator-associated pneumonia:a comparison of histologic, microbiologic, and clinical criteria [J]. Chest 1997; 112:445-57.
[42]Fartoukh M, Maitre B, Honore S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation:the clinical pulmonary infection score revisited [J]. Am J Respir Crit Care Med 2003; 168:173-9.
[43]Niederman MS. The clinical diagnosis of ventilator-associated pneumonia [J]. Respir Care 2005; 50:788-96.
[44]Alp E, Voss A. Ventilator associated pneumonia and infection control [J]. Ann Clin Microbiol Antimicrob,2006,5:7.
[45]Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia [J]. Chest 2006; 130:597-604.
[46]Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid [J]. Am Rev Respir Dis 1991; 143:1121-9.
[47]Papazian L, Thomas P, Garbe L, et al. Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia [J]. Am J Respir Crit Care Med 1995; 152:1982-91.
[48]Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription [J]. Am J Respir Crit Care Med 2000; 162:505-11.
[49]Mayhall CG. Ventilator-associated pneumonia or not? Contemporary diagnosis [J]. Emerg Infect Dis 2001; 7:200-4.
[50]Baselski VS, el-Torky M, Coalson JJ, Griffin JP. The standardization of criteria for processing and interpreting laboratory specimens in patients with suspected ventilator-associated pneumonia [J]. Chest 1992; 102:571S-9S.
[51]Duflo F, Allaouchiche B, Debon R, Bordet F, Chassard D. An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia [J]. Anesth Analg 2001; 92: 442-7.
[52]Sirvent JM, Vidaur L, Gonzalez S, et al. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilator-associated pneumonia [J]. Chest 2003; 123: 518-23.
[53]Chastre J, Fagon JY, Bornet-Lecso M, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia [J]. Am J Respir Crit Care Med 1995; 152:231-40.
[54]Blot F, Raynard B, Chachaty E, Tancrede C, Antoun S, Nitenberg G. Value of gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia [J]. Am J Respir Crit Care Med 2000; 162:1731-7.
[55]Luna CM, Chirino A. Qualitative cultures in ventilator-associated pneumonia—can they be used with confidence? [J]. Crit Care 2004; 8: 425-6.
[56]Brun-Buisson C, Fartoukh M, Lechapt E, et al. Contribution of blinded, protected quantitative specimens to the diagnostic and therapeutic management of ventilator-associated pneumonia [J]. Chest 2005; 128: 533-14.
[57]Camargo LF, De Marco FV, Barbas CS, et al. Ventilator associated pneumonia:comparison between quantitative and qualitative cultures of tracheal aspirates [J]. Crit Care 2004; 8:R422-30.
[58]Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece [J]. Respir Care 2003;48:681-8.
[59]毛晓清,唐春莲,杨超群.重症监护病房呼吸机相关性肺炎危险因素的前 瞻性研究[J].现代预防医学,2010,,37(13)：2567-2568.
[60]ChevretS, HemmerM, Carlet J, LangerM. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia [J]. Intensive Care Med 1993; 19:256-64.
[61]屈磊,龚传明,章涛,文峰,滕维亚.呼吸机相关性肺炎危险因素分析[J].局解手术学杂志,2011,20(1)：89-90.
[62]Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia:comparing adult critical-care populations [J]. Am J Respir Crit Care Med 1996; 153:158-62.
[63]于洪涛,贾金广,王敏,臧金平,刘艳红.呼吸重症监护病房呼吸机相关性肺炎的危险因素分析[J].中国呼吸与危重监护杂志,2011,10(1)：69-71.
[64]Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumoniaina community hospital:risk factors and clinical outcomes [J]. Chest 2001; 120:555-61.
[65]梁英英,钱小毛.重症监护病房呼吸机相关性肺炎的危险因素分析[J].中华医院感染学杂志,2010,20(6)：799-800.
[66]Torres A, Aznar R, Gatell JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients [J]. Am Rev Respir Dis 1990; 142:523-8.
[67]Chastre J. Conference summary:ventilator-associated pneumonia [J]. Respir Care 2005; 50:975-83.
[68]Rouby JJ, Laurent P, Gosnach M,et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill [J]. Am J Respir Cri Care Med 1994,150(3):776-783.
[69]Wip C, Napolitano L. Bundles to prevent ventilator-associated pneumonia: how valuable are they? [J]. Curr Opin Infect Dis,2009,22(2),159-166.
[70]Van Saene HK, Silvestri L, De La Cal MA, Baines P. The emperor's new clothes:the fairy tale continues [J]. J Crit Care,2009,24(1):149-152.
[71]Zilberberg MD, Shorr AF, Kollef MH. Implementing quality improvements in the intensive care unit:ventilator bundle as an example [J]. Crit Care Med, 2009,37(1):305-309.
[72]Mahul P, Auboyer C, Jospe R et al. Prevention of nosocomial pneumonia in intubated patients:respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis [J]. Intens Care Med.1992, 18(1):20-25.
[73]张宪芬,张瑞英,焦瑞娟.持续声门下吸引在机械通气患者中的应用效果研究[J].中国实用神经疾病杂志,2010,13(5)：77.
[74]Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia:European perspective [J]. Intensive Care Med 2009; 35(1),9-29.
[75]Van Nieuwenhoven CA, Vandenbroucke-Grauls C, Van Tiel FH et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia:a randomized study [J]. Crit. Care Med,2006,34(2), 396-402.
[76]Bouza E, Perez MJ, Munoz P, Rincon C, Barrio JM, Hortal J. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery [J]. Chest 2008, 134(5),938-946.
[77]尤荣开,邵朝朝,薛丽珠,王仁数.声门下分泌物引流对呼吸机相关性肺炎发病的影响[J].中国呼吸与危重监护杂志,2010,9(3)：318-319.
[78]Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients:role of respiratory airway care [J]. Am J Respir Crit Care Med,1996,154(1):111-115.
[79]Torres A, Serra-Batlles J, Ros E et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation:the effect of body position [J]. Ann Intern Med 992,116(7):540-543.
[80]Kollef MH. Ventilator-associated pneumonia:A multivariate analysis [J]. JAMA 1993,270(16):1965-1970.
[81]Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients:a randomised trial [J]. Lancet 1999, 354(9193):1851-1858.
[82]蔡卫新,苏丹.机械通气管路中冷凝水的管理[J].中华护理杂志,2010,45(6)：552-553.
[83]Kollef MH, Afessa B, Anzueto A et al. Silvercoated endotracheal tubes and incidence of ventilator-associated pneumonia:the nascent randomized trial [J]. JAMA 2008,300(7),805-813.
[84]Augustyn B. Ventilator-Associated Pneumonia Risk Factors and Prevention [J]. Critical Care Nurse,2007; 27:32-39
[85]Van Nieuwenhoven CA, Buskens E, Bergmans DC, van Tiel FH, Ramsay G, Bonten MJ. Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units [J]. Critical Care Medicine,2004,32(1):126-130.
[86]Lorente L., Blot S., Rello J. Evidence on measures for the prevention of ventilator-associated pneumonia [J]. Eur Respir J 2007; 30:1193-1207.
[2]Haley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals[J]. Am J Epidemiol 1985; 121:182-205.
[3]朱士俊,郭燕红,李六亿,等.医院感染管理工作现状与展望[J].中国医院.2007,11(1)：6-9.
[4]黄勋,吴安华,徐秀华.医院安全与医院感染刍议[J].中国护理管理.2005,5(1)：12-14.
[5]Cauet D, Quenon JL, Desve G. Surveillance of hospital acquired infections: presentation of a computerised system[J]. Eur J Epidemiol 1999; 15:149-153.
[6]Sanchez-Paya J, Bischofberger C, Lizan M, et al. Nosocomial infection surveillance and control:current situation in Spanish hospitals[J]. J Hosp Infect 2009; 72:50-56.
[7]Gikas A, Pediaditisy J, Papadakis JA, et al. Prevalence study of hospital-acquired infections in 14 Greek hospitals:planning from the local to the national surveillance level[J]. J Hosp Infect 2002; 50:269-275.
[8]Hopmans TEM, Blok HEM, Troelstra A, Bonten MJM. Prevalence of hospital-acquired infections during successive surveillance surveys conducted at a university hospital in The Netherlands [J]. Infect Control Hosp Epidemiol 2007; 28:459-465.
[9]任南,文细毛,吴安华.全国医院感染横断面调查结果的变化趋势研究[J].中国感染控制杂志,2007,6(1)：16-18.
[10]任南,文细毛,吴安华,徐秀华,易霞云,巩玉秀.178所医院医院感染危险因素调查分析[J].中国感染控制杂志,2003,2(1)：6-10.
[11]Gastmeier P,Balderjahn SS,Hansen S,et al.How outbreaks Can contribute to prevention ofnosocomial infection:Analysis of 1022 outbreaks[J]. Infect Control Hosp Epidemiol.2005; 26(4):357-362.
[12]王红梅,索瑶,李金娜,等.典型医院感染事件分析及对策[J].现代预防医学,2010,37(20)：3994-3997.
[13]裴霞.医院感染的横断面调查与分析[J].中华疾病控制杂志,2010,14(8)：810-811.
[14]马文晖,王力红,张京利,等.连续3年医院感染现患率调查分析[J].中华医院感染学杂志,20(1)：23-25.
[15]Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections,1988[J]. Am J Infect Control 1988; 16:128-140.
[16]Wilsonl APR, Hodgsonl B, Liu M, et al. Reduction in wound infection rates by wound surveillance with postdischarge follow-up and feedback[J]. Brit J Surg 2006; 93:630-638.
[17]Barwolff S, Sohr D, Geffers C, et al. Reduction of surgical site infections after caesarean delivery using surveillance [J]. J Hosp Infect 2006; 64:156-161.
[18]Berthelot P, Gamier M, Fascia P, et al. Conversion of prevalence survey data on nosocomial infections to incidence estimates:a simplified tool for surveillance? [J]. Infect Control Hosp Epidemiol 2007; 28:633-636.
[19]Morton AP, Clements ACA, Doidge SR, Stackelroth J, Curtis M, Whitby M. Surveillance of healthcare-acquired infections in queensland, australia:data 695-701. and lessons from the first 5 years [J]. Infect Control Hosp Epidemiol 2008; 29:
[20]Lanini S, Jarvis WR, Nicastri E, et al. Healthcare-associated infection in Italy: annual point-prevalence surveys,2002-2004[J]. Infect Control Hosp Epidemiol 2009; 30:659-665.
[21]Eriksen HM, IversenBG, Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway,2002 and 2003 [J]. J Hosp Infect 2005; 60:40-45.
[22]王悦,张鲁涛,史利克,等.1483例住院患者医院感染横断面调查及分析[J].中华医院感染学杂志.2010,20(17)：2566-2569.
[23]张晓卿.医院感染现患率调查情况与分析[J].现代预防医学,2010,37(13)：2461-2466.
[24]任南,文细毛,吴安华.2008年全国医院感染横断面调查报告[J].中国医院协会第十六届医院感染管理学术年会论文集,2009：396-399.
[25]Faria S, Sodano L, Gjata A, et al. The first prevalence survey of nosocomial infections in the University Hospital Centre'Mother Teresa' of Tirana, Albania[J]. J Hosp Infec 2007; 65:244-250.
[26]Selma M, Yurdanur A, Gul D, Cemalettin K. Prevalence and characteristics of nosocomial infections in a Turkish university hospital[J]. AJIC 2004; 20: 409-413.
[27]Gastmeier P. European perspective on surveillance [J]. J Hosp Infect 2007; 65(S2):159-164.
[28]Perencevich EN, McGregor JC, Shardell M, et al. Summer peaks in the incidences of gram-negative bacterial infection among hospitalized patients[J]. Infect Control Hosp Epidemiol 2008; 29:1124-1131.
[29]Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ET. The Second National Prevalence Survey of infection in hospitals—overview of the results [J]. J Hosp Infect.1996; 32:175-190.
[30]Bergogne, Berezin E. Current guidelines for the treatment and prevention of nosocomial infections [J]. Drugs 1999; 58:51-67.
[31]任南,文细毛,吴安华,李洁,徐秀华.教学医院与非教学医院的医院感染比较研究[J].中华医院感染学杂志,2004,14(3)：261-264.
[32]Wang A, Fan S, Yang Y, Shen X. Nosocomial infections among pediatric hematology patients:results of a retrospective incidence study at a pediatric hospital in China[J]. J Pediatr Hematol Oncol 2008; 30:674-678.
[33]Eggimann P, Pittet D. Infection control in the ICU. Chest 2001; 120:2059-2093.
[34]A report from the NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004[J]. Am J Infect Control 2004; 32:470-485.
[35]Ansari F, Erntell M, Goossens H, Davey P. The European Surveillance of Antimicrobial Consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006[J]. Clin Infect Dis 2009; 49:1496-1504.
[36]文细毛,任南,吴安华等.全国医院感染监控网细菌耐药情况及变化趋势[J].中国感染控制杂志,2009,8(6)：389-408.
[37]Xie DS, Xiong W, Xiang LL, et al. Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China,2007-2008[J]. J Hosp Infect 2010; 76:150-155.
[38]Chastre J, Fagon JY. Ventilator-associated pneumonia[J]. Am J Respir Crit Care Med 2002; 165:867-903.
[39]Cavalcanti M, Valencia M, Torres A. Respiratory nosocomial infections in the medical intensive care unit[J]. Microbes Infect 2005; 7:292-301.
[40]Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia:A systematic review[J]. Crit Care Med 2005; 33:2184-93.
[41]Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient[J]. Am J Respir Crit Care Med 1999; 159:1249-56.
[42]Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group. Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database[J]. Chest 2002; 122:2115-21.
[43]Marik PE. An evidence-based approach to the diagnosis of ventilator-associated pneumonia[J]. Respir Care 2009; 54:1453-61.
[44]Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:incidence and risk factors [J]. J Infect Dev Ctries 2009; 3:771-7.
[45]Edwards JR, Peterson KD, Andrus ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007[J]. Am J Infect Control 2007; 35:290-301.
[46]Meyer E, D. Sohr, Gastmeier P, Geffers C. New identification of outliers and ventilator associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System[J]. J of Hosp Infect 2009; 73: 246-52.
[47]Blamoun J, Alfakir M, Rella ME, et al. Efficacy of an expanded ventilator bundle for the reduction of ventilatorassociated pneumonia in the medical intensive care unit[J]. Am J Infect Control 2009; 37:172-5.
[48]Al-Tawfiq JA, Abed MS. Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle [J]. Am J Infect Control 2010; 38:552-6.
[49]孙铁英,李燕明,胡云建,等.呼吸机相关性肺炎临床资料和危险因素的回顾分析[J].中华内科杂志,2002,41(7)：468-471.
[50]金浩承,何礼贤.呼吸机相关性肺炎的病原学诊断技术与临床意义[J].中国呼吸与危重监护杂志,2004,3(5)：329-331.
[51]Moreno CA, Rosenthal VD, Olarte N, et al. Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals:Findings of the International Nosocomial Infection Control Consortium [J]. Infect Control Hosp Epidemiol 2006; 27:349-56.
[52]Tejerina E, Frutos-Vivar F, I.Restrepo M, et al.Incidence, risk factors, and outcome of ventilator-associated pneumonia[J]. J Crit Care 2006; 21:56-65.
[53]Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing:16th information supplement[M] M100-S18. Wayne, PA.2006.
[54]Giard M, Lepape A, Allaouchiche B, et al. Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit:comparison of risk factors[J]. J Crit Care 2008; 23:27-33.
[55]Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco:Findings of the International Nosocomial Infection Control Consortium (INICC) [J]. Int Arch Med 2009,2:29-36.
[56]Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries:a systematic review[J]. Int J of Infect Dis 2008; 12:505-12.
[57]李华茵,何礼贤,胡必杰,等.重症监护病房呼吸机相关肺炎临床与病原学分析[J].中国呼吸与危重监护杂志,2006,4(4)：266-270.
[58]徐炎,张乐嘉,戈海廷,等.新生儿重症监护病房的院内感染638例分析[J].中华儿科杂志,2007,45(6)：437-441.
[59]Razaa MW, Kazib BM, Mustafac M, Gould FK. Developing countries have their own characteristic problems with infection control[J]. J Hosp Infect 2004; 57: 294-9.
[60]Napolitano LM. Use of Severity Scoring and Stratification Factors in Clinical Trials of Hospital-Acquired and Ventilator-Associated Pneumonia[J]. Clin Infect Dis 2010; 51:S67-80.
[61]张永利,范姝文,万献尧.重症监护病房中呼吸机相关性肺炎相关因素分析[J].中国医师杂志,2006,8(3)：380-381.
[62]张亚莉,耿穗娜,汪能平,等.呼吸机相关性肺炎临床与病原菌特点分析[J].中华医院感染学杂志,2006,16(4)：453-456.
[63]Kollef MH. Prevention of hospital-associated pneumonia and ventilator- associated pneumonia[J]. Crit Care Med 2004; 32:1396-405.
[64]黄苒.重症监护病房发生呼吸机相关性肺炎的病原菌分析及护理[J].中国医学工程,2010,18(2)：105-106.
[65]张玉莲,何小静,郭剑,等.气管切开术后呼吸道病原菌分布及相关因素研究[J].中华医院感染学杂志,2009,19(10)：1296-1298.
[66]Medina J, Formento C, Pontet J, et al. Prospective study of risk factors for ventilator-associated pneumonia caused by Acinetobacter species[J].J Crit Care 2007,22:18-26.
[67]Lagamayo EN. Antimicrobial resistance in major pathogens of hospital-acquired pneumonia in Asian countries[J]. Am J Infect Control 2008; 36:S101-8.
[68]Suetens C, Morales I, Savey A, et al. European surveillance of ICU-acquired infections (HELICS-ICU):methods and main results[J]. J Hosp Infect 2007; 65: 171-3.
[69]Lizioli A, Privitera G, Alliata E, et al. Prevalence of nosocomial infections in Italy:result from the Lombardy survey in 2000[J]. J Hosp Infect 2003; 54: 141-8.
[70]Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study[J]. JAMA 1995; 274:639-44.
[71]Erben N, Alpat SN, Kartal ED. Analysis of the risk factors in nosocomial urinary tract infections and effect of urinary catheter use on distribution of the causative agents [J]. Mikrobiyol Bul 2009; 43:77-82.
[72]Rosenthal VD, Maki DG, Jamulitrat S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009 [J]. Am J Infect Control 2010; 38:95-106.
[73]Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria[J]. Am J Infect Control 2000; 28:68-75.
[74]Edwards JR, MStat, Peterson KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008[J]. Am J Infect Control 2008; 36:609-26.
[75]Zolldann D, Thiex R, Hafner H, et al. Periodic surveillance of nosocomial infections in a neurosurgery intensive care unit[J]. Infect 2005; 33:115-21.
[76]Talaat M, Hafez S, Saied T. Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexandria university hospitals in Egypt [J]. Am J Infect Control 2010; 38:222-8.
[77]Rosenthal VD, Guzman RN, Crnich C. Device-associated nosocomial infection rates in intensive care units of Argentina[J]. Infect Control Hosp Epidemiol 2004; 25:251-5.
[78]Rothfeld AF, Stickley A. A program to limit urinary catheter use at an acute care hospital[J]. Am J Infect Control 2010; 4:1-4.
[79]陈红花.导尿管相关尿路感染危险因素调查分析[J].中华医院感染学杂志,2008,18(9)：1276-1278.
[80]Saint S, Lipsky BA. Preventing catheter-related bacteriuria:should we? Can we? How? [J]. Arch Intern Med 1999; 159:800-8.
[81]Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters[J]. Emerg Infect Dis 2001; 7:342-7.
[82]Wyndaele JJ. Complications of intermittent catheterization:their prevention and treatment[J]. Spinal Cord 2002; 40:536-41.
[83]Storfer SP, Medoff G, Fraser VJ, Powderly WG, Dunagan WC.Candiduria: retrospective review in hospitalized patients [J]. Infect Dis Clin Pract 1994; 3:23-9.
[84]Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients [J]. Clin Infect Dis 2000; 30:14-8.
[85]Kallas HE, Chintanadilok J, Maruenda J. Treatment of nocturia in the elderly [J]. Drugs Aging.1999; 15:429-37.
[86]Mojtahedzadeh M, Panahi Y, Fazeli MR, et al. Intensive care unit-acquired urinary tract infections in patients admitted with sepsis:etiology, risk factors, and patterns of antimicrobial resistance [J]. Int J Infect Dis 2008; 12:312-8.
[87]Laupland KB, Bagshaw SM, Gregson DB, Kirkpatrick AW, Ross T, Church DL. Intensive care unit-acquired urinary tract infections in a regional critical care system[J]. Crit Care 2005; 9:R60-5.
[88]Rosser CJ, Bare RL, Meredith JW. Urinary tract infections in the critically ill patient with a urinary catheter [J]. Am JSurg 1999; 177:287-90.
[89]马晓波,吕晓菊,过孝静,等.5771份尿培养结果分析及药敏监测[J].四川大学学报,2007,38(4)：745-747.
[90]Alvarez-Lerma F, Nolla-Salas J, Leon C, et al. Candiduria in critically ill patients admitted to intensive care medical units [J]. Intens Care Med 2003; 29:1069-76.
[91]Gubbins PO, Piscitelli SC, DanzigerLH. Candidal urinay tract infections:a comprehensive review of their diagnosis and management [J]. Pharmacotherapy 1993; 13:110-27.
[92]Leone M, Albanese J, Gamier F, et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit [J]. Intens Care Med 2003; 29:1077-80.
[93]叶海云,侯树坤,曲星珂,等.细菌生物膜对尿管相关性尿路感染的影响[J].中华泌尿外科杂志,2006,27(2)：135-138.
[94]Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults:2009 international clinical practice guidelines from the infectious diseases society of America[J]. Clin Infect Dis 2010; 50:625-63.
[95]施金芬,王建荣,马燕兰.重危患者留置尿管表面生物被膜形成的观察[J].解放军护理杂志,2009,26(4B)：10-16.
[96]Gardam MA, Amihod B, Orenstein P, Consolacion N, Miller MA. Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections[J]. Clin Perform Qual Health Care 1998; 6:99-102.
[97]Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients[J]. Arch Intern Med 1995; 155:1425-9.
[98]Elpern EH, Killeen K, Ketchem A, Wiley A, Patel G, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections [J]. Am J Crit Care 2009; 18:535-41.
[99]牛家兰.留置导尿患者预防尿路感染的护理进展[J].安徽医学,2010,31(7)：52-853.
[100]王力红,赵霞,张京利,杨淼,马文晖.重症监护病房医院感染预警模型的建立[J].中华医院感染学杂志,2010,20(21)：3368-3370.
[101]罗阳,丁国英,府伟灵,等.季节性时间序列分析在医院感染中的应用[J].中华医院感染学杂志2005,15(4)：390-392.
[102]许林勇,白毅,胡明,等.基于人工神经网络模型的医院感染危险度预测[J].中南大学学报(医学版)2006,31(3)：404-407.
[103]姜天俊,闫子国,赵敏,等.晚期肝病患者并发真菌感染的早期预警指标研究[J].临床肝胆病杂志2007,(23)：362-364.
[104]El-Solh AA, Hsiao CB, Goodnough S, Serghani J, Grant BJ. Predicting active pulmonary tuberculosis using an artificial neural network[J]. Chest.1999, 116(4):968-73.
[105]Lammers RL, Hudson DL, Seaman ME. Prediction of traumatic wound infection with a neural network-derived decision model[J]. Am J Emerg Med. 2003,21(1):1-7.
[106]Dybowski R, Weller P, Chang R, Gant V. Prediction of outcome in critically ill patients using artificial neural network synthesised by genetic algorithm [J]. Lancet.1996; 347(9009):1146-50.
[107]Eftekhar B, Mohammad K, Ardebili HE, Ghodsi M, Ketabchi E. Comparison of artificial neural network and logistic regression models for prediction of mortality in head trauma based on initial clinical data[J]. BMC Med Inform Decis Mak.2005; 5:3.
[108]Wang CH, Mo LR, Lin RC, Kuo JJ, Chang KK, Wu JJ. Artificial neural network model is superior to logistic regression model in predicting treatment outcomes of interferon-based combination therapy in patients with chronic hepatitis C[J]. Intervirology.2008,51(1):14-20.
[109]张京利,赵霞,王力红,马文晖,王桂珍.重症监护病房患者医疗干预措施与医院感染的相关性研究[J].中华医院感染学杂志,2010,20(2)：187-189.
[110]许林勇,张延霞,田晓丽,漆冰,等.医院感染危险度的预测预报[J].中国医师杂志,2004,6(2)：165-167.
[111]Natalie M. Spearing,etl. Direct costs associated with a nosocomial outbreak of Salmonella infection:An ounce of prevention is worth a pound of cure[J]. Association for Professionals in Infection Control and Epidemiology,2000, 28(1):54-57.
[112]Utsumi M., Makimoto K., Quroshi N., Ashida N. Types of infectious outbreaks and their impact in elderly care facilities:a review of the literature [J]. Age and Ageing 2010; 39:299-305.
[113]Petra Gastmeier, Sabine Stamm-Balderjahn, Sonja Hansen,et tl. How outbreaks can contribute to prevention of nosocomial infection:analysis of 1,022 outbreaks[J]. Infect Control Hosp Epidemiol,2005,26(4):357-361.
[114]徐秀华.临床医院感染学[M]长沙：湖南科学技术出版社,2005,65.
[115]Gastmeier P., Loui A., Stamm-Balderjahn S, et al. Outbreaks in neonatal intensive care units— They are not like others[J]. AJIC,2007; 35:172-6.
[116]V Rabier, S Bataillon, A Jolivet-Gougeon,et al. Hand washing soap as a source of neonatal Serratia marcescens outbreak[J]. Acta Pcediatrica,2008,1381-1385.
[117]Carlos Sanchez-Carrillo, PharmD,Bele'n Padilla, MD, Mercedes Marin, Phd,et al. Contaminated feeding bottles:The source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit[J]. AJIC,2009,37(2): 150-154.
[118]Nehad Nasef, Karel O'Brien, Lesley Wylie,etl.Leesesarscho anrticsle from SARS:A retrospective study of outpatient care during an infectious disease outbreak[J].BMC Pediatrics,2010,1-6.
[119]SARS Investigation Team from DMERI,and SGH. Strategies adopted and lessons learnt during the severe acute respiratory syndrome crisis in Singapore[J]. Wiley InerScience,2004,15:57-70.
[120]曾光SARS危机与中国公共卫生的进步[J].安徽预防医学杂志,2007,13(4)：241-244.
[121]邱泽青.浅谈我国突发公共卫生事件应急预案体系的构成与管理[J].现代预防医学,2008,35(12)：2350-2355.
[122]舒明蓉,李大江,王星月,等.如何提高医院感染监测系统灵敏度和特异度[J].现代预防医学,2007,34(9)：1776-1778.
[123]朱宏,孙树梅,陈莉雅,等.医院感染暴发的监测与预警[J].南方医科大学学报,2008,28(8)：1458-1462.
[124]Alina Filozov, Paul Visintainer, Carol Carbonaro, et al. Epidemiology of an outbreak of antibiotic-resistant Klebsiella pneumoniae at a tertiary care medical center[J]. AJIC,2009,37(9):723-728.
[125]乔甫,康梅,谭成,等PFGE在识别和追踪医院感染暴发及流行中的应用[J].现代预防医学,2007,34(14)：2660-2663.
[126]张国荣,钟初雷,陈文光.医院感染预警系统的建立与应用[J].中华医院感染学杂志,2007,17(2)：176-178.
[127]王力红,张京利,马文晖,等.从医院感染暴发谈医疗机构危机管理[J].中国医院,2008,12(8)：36-38.
[128]黄伟灿,吕世伟,李堂林.试论我国公共卫生应急体系的构建[J].中华医院管理杂志,2003,19(10)：577-579.
[129]赵琦,赵根明,韦建国,等.突发公共卫生事件应急体系建设内涵[J].中国公共卫生管理,2008,24(5)：477-479.
[1]Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient[J]. Am J Respir Crit Care Med 1999; 159: 1249-1256.
[2]Chastre J, Fagon JY. Ventilator-associated pneumonia [J].Am J Respir Crit Care Med 2002; 165:867-903.
[3]Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review [J]. Crit Care Med.2005,33(10),2184-2193.
[4]Beyersmann J, Gastmeier P, Grundmann H, et al. Use of multistate models to assess prolongation of intensivecare unit stay due to nosocomial infection[J]. Infec Control Hosp Epidemiol.2006,27(5),493-499.
[5]Morris AC, Kefala K, Simpson AJ, et al. Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia [J]. Thorax 2009,64(6),516-522.
[6]Richards MJ,Edwards JR,Culver DH,Gaynes RP.Nosocomial infections in medical intensive care units in the United States.National Nosocomial Infections Surveillance System [J]. Crit Care Med 1999; 27:887-92.
[7]Kollef MH.What is ventilator-associated pneumonia and why is it important? [J]. Respir Care 2005; 50:714-21.
[8]Edwards JR, Peterson KD, Andrus ML, et al National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007[J]. Am J Infect Control 2007; 35:290-301.
[9]Meyer E, D. Sohr, Gastmeier P, Geffers C. New identification of outliers and ventilator associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System [J]. J of Hosp Infect 2009; 73:246-52.
[10]Giard M, Lepape A, Allaouchiche B, et al. Early-and late-onset ventilator-associated pneumonia acquired in the intensive care unit:comparison of risk factors[J]. J Crit Care 2008; 23:27-33.
[11]Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:incidence and risk factors [J]. J Infect Dev Ctries 2009; 3:771-7.
[12]Moreno CA, Rosenthal VD, Olarte N, et al. Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium [J]. Infect Control Hosp Epidemiol 2006; 27:349-56.
[13]Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco:Findings of the International Nosocomial Infection Control Consortium (INICC) [J]. Int Arch Med 2009, 2:29-36.
[14]Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries:a systematic review [J]. Int J of Infect Dis 2008; 12:505-12.
[15]金浩承,何礼贤.呼吸机相关性肺炎的病原学诊断技术与临床意义[J].中国呼吸与危重监护杂志,2004,3(5)：329-331.
[16]Rello J, Quintana E, Ausina V et al. Incidence, etiology, and outcome of nosocomial pneumonia in mechanically ventilated patients [J]. Chest 1991, 100(2),439-444.
[17]Tejerina E, Frutos-Vivar F, Restrepo MI et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia [J]. J. Crit. Care.2006,21(1), 56-65.
[18]Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units [J]. JAMA 1996,275(11),866-869.
[19]倪菊平,倪金迪,余跃天,王成碧,刘春艳.呼吸机相关性肺炎的危险因素及病原学研究[J].内科急危重症杂志,2010,16(3)：143-147.
[20]Nguile-Makao M, Zahar JR, Francais A et al. Attributable mortality of ventilatorassociated pneumonia:respective impact of main characteristics at icu admission and vap onset using conditional logistic regression and multi-state models[J]. Intensive Care Med.2010,36(5),781-789.
[21]Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system [J]. J. Crit. Care, 2008,23(1):5-10.
[22]Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database [J]. Chest 2002; 122: 2115-21.
[23]Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit:a case-control study [J]. BMC Pulm Med 2004; 4:3.
[24]Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia:its relevance to developing effective strategies for prevention [J]. Respir Care,2005,50:725-39.
[25]孙耕耘.关注吸入性肺炎的防治.临床肺科杂志,2008,13(7)：819-820.
[26]Ewig S, Torres A, El-Ebiary M, et al. Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia [J]. Am J Respir Crit Care Med 1999; 159:188-98.
[27]Bergmans DC, Bonten MJ, van Tiel FH, et al. Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit [J]. Thorax 1998;53:1053-8.
[28]Torres A, El-Ebiary M, Soler N, Monton C, Fabregas N, Hernandez C. Stomach as a source of colonization of the respiratory tract during mechanical ventilation:association with ventilator-associated pneumonia [J]. Eur Respir J 1996; 9:1729-35.
[29]Koenig SM, Truwit JD. Ventilator-associated pneumonia:diagnosis, treatment, and prevention [J]. Clin Microbiol Rev 2006; 19:637-57.
[30]Park DR. The microbiology of ventilator-associated pneumonia [J]. Respir Care 2005; 50:742-63.
[31]Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India:role of multi-drug resistant pathogens [J]. J Infect Dev Ctries 2010; 4:218-25.
[32]孙铁英,李燕明,胡云建,明树红.呼吸机相关性肺炎临床资料和危险因素的回顾分析[J].中华内科杂志,2002,41(7)：468-471.
[33]Craven DE. Epidemiology of ventilator-associated pneumonia [J]. Chest, 2000; 117:186S-7S.
[34]Niederman MS, Craven DE. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia [J]. Am J Respir Crit Care Med,2005; 171:388-416.
[35]Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii [J]. Antimicrob Agents Chemother 2007; 51:3471-84.
[36]Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat [J]. Clin Microbiol Rev 2001; 14:933-51.
[37]Torres A, Carlet J. Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia [J]. Eur Respir J 2001; 17:1034-45.
[38]Combes A, Figliolini C, Trouillet JL, et al. Incidence and outcome of polymicrobial ventilator-associated pneumonia [J]. Chest 2002; 121: 1618-23.
[39]Marquette CH, Copin MC, Wallet F, et al. Diagnostic tests for pneumonia in ventilated patients:prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard [J]. Am J Respir Crit Care Med 1995; 151:1878-88.
[40]Rouby JJ, Martin DL, Poete P, et al. Nosocomial bronchopneumonia in the critically ill. Histologic and bacteriologic aspects [J]. Am Rev Respir Dis 1992; 146:1059-66.
[41]Kirtland SH, Corley DE, Winterbauer RH, et al. The diagnosis of ventilator-associated pneumonia:a comparison of histologic, microbiologic, and clinical criteria [J]. Chest 1997; 112:445-57.
[42]Fartoukh M, Maitre B, Honore S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation:the clinical pulmonary infection score revisited [J]. Am J Respir Crit Care Med 2003; 168:173-9.
[43]Niederman MS. The clinical diagnosis of ventilator-associated pneumonia [J]. Respir Care 2005; 50:788-96.
[44]Alp E, Voss A. Ventilator associated pneumonia and infection control [J]. Ann Clin Microbiol Antimicrob,2006,5:7.
[45]Porzecanski I, Bowton DL. Diagnosis and treatment of ventilator-associated pneumonia [J]. Chest 2006; 130:597-604.
[46]Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid [J]. Am Rev Respir Dis 1991; 143:1121-9.
[47]Papazian L, Thomas P, Garbe L, et al. Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia [J]. Am J Respir Crit Care Med 1995; 152:1982-91.
[48]Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription [J]. Am J Respir Crit Care Med 2000; 162:505-11.
[49]Mayhall CG. Ventilator-associated pneumonia or not? Contemporary diagnosis [J]. Emerg Infect Dis 2001; 7:200-4.
[50]Baselski VS, el-Torky M, Coalson JJ, Griffin JP. The standardization of criteria for processing and interpreting laboratory specimens in patients with suspected ventilator-associated pneumonia [J]. Chest 1992; 102:571S-9S.
[51]Duflo F, Allaouchiche B, Debon R, Bordet F, Chassard D. An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia [J]. Anesth Analg 2001; 92: 442-7.
[52]Sirvent JM, Vidaur L, Gonzalez S, et al. Microscopic examination of intracellular organisms in protected bronchoalveolar mini-lavage fluid for the diagnosis of ventilator-associated pneumonia [J]. Chest 2003; 123: 518-23.
[53]Chastre J, Fagon JY, Bornet-Lecso M, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia [J]. Am J Respir Crit Care Med 1995; 152:231-40.
[54]Blot F, Raynard B, Chachaty E, Tancrede C, Antoun S, Nitenberg G. Value of gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia [J]. Am J Respir Crit Care Med 2000; 162:1731-7.
[55]Luna CM, Chirino A. Qualitative cultures in ventilator-associated pneumonia—can they be used with confidence? [J]. Crit Care 2004; 8: 425-6.
[56]Brun-Buisson C, Fartoukh M, Lechapt E, et al. Contribution of blinded, protected quantitative specimens to the diagnostic and therapeutic management of ventilator-associated pneumonia [J]. Chest 2005; 128: 533-14.
[57]Camargo LF, De Marco FV, Barbas CS, et al. Ventilator associated pneumonia:comparison between quantitative and qualitative cultures of tracheal aspirates [J]. Crit Care 2004; 8:R422-30.
[58]Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece [J]. Respir Care 2003;48:681-8.
[59]毛晓清,唐春莲,杨超群.重症监护病房呼吸机相关性肺炎危险因素的前 瞻性研究[J].现代预防医学,2010,,37(13)：2567-2568.
[60]ChevretS, HemmerM, Carlet J, LangerM. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia [J]. Intensive Care Med 1993; 19:256-64.
[61]屈磊,龚传明,章涛,文峰,滕维亚.呼吸机相关性肺炎危险因素分析[J].局解手术学杂志,2011,20(1)：89-90.
[62]Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia:comparing adult critical-care populations [J]. Am J Respir Crit Care Med 1996; 153:158-62.
[63]于洪涛,贾金广,王敏,臧金平,刘艳红.呼吸重症监护病房呼吸机相关性肺炎的危险因素分析[J].中国呼吸与危重监护杂志,2011,10(1)：69-71.
[64]Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. The occurrence of ventilator-associated pneumoniaina community hospital:risk factors and clinical outcomes [J]. Chest 2001; 120:555-61.
[65]梁英英,钱小毛.重症监护病房呼吸机相关性肺炎的危险因素分析[J].中华医院感染学杂志,2010,20(6)：799-800.
[66]Torres A, Aznar R, Gatell JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients [J]. Am Rev Respir Dis 1990; 142:523-8.
[67]Chastre J. Conference summary:ventilator-associated pneumonia [J]. Respir Care 2005; 50:975-83.
[68]Rouby JJ, Laurent P, Gosnach M,et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill [J]. Am J Respir Cri Care Med 1994,150(3):776-783.
[69]Wip C, Napolitano L. Bundles to prevent ventilator-associated pneumonia: how valuable are they? [J]. Curr Opin Infect Dis,2009,22(2),159-166.
[70]Van Saene HK, Silvestri L, De La Cal MA, Baines P. The emperor's new clothes:the fairy tale continues [J]. J Crit Care,2009,24(1):149-152.
[71]Zilberberg MD, Shorr AF, Kollef MH. Implementing quality improvements in the intensive care unit:ventilator bundle as an example [J]. Crit Care Med, 2009,37(1):305-309.
[72]Mahul P, Auboyer C, Jospe R et al. Prevention of nosocomial pneumonia in intubated patients:respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis [J]. Intens Care Med.1992, 18(1):20-25.
[73]张宪芬,张瑞英,焦瑞娟.持续声门下吸引在机械通气患者中的应用效果研究[J].中国实用神经疾病杂志,2010,13(5)：77.
[74]Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia:European perspective [J]. Intensive Care Med 2009; 35(1),9-29.
[75]Van Nieuwenhoven CA, Vandenbroucke-Grauls C, Van Tiel FH et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia:a randomized study [J]. Crit. Care Med,2006,34(2), 396-402.
[76]Bouza E, Perez MJ, Munoz P, Rincon C, Barrio JM, Hortal J. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery [J]. Chest 2008, 134(5),938-946.
[77]尤荣开,邵朝朝,薛丽珠,王仁数.声门下分泌物引流对呼吸机相关性肺炎发病的影响[J].中国呼吸与危重监护杂志,2010,9(3)：318-319.
[78]Rello J, Sonora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients:role of respiratory airway care [J]. Am J Respir Crit Care Med,1996,154(1):111-115.
[79]Torres A, Serra-Batlles J, Ros E et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation:the effect of body position [J]. Ann Intern Med 992,116(7):540-543.
[80]Kollef MH. Ventilator-associated pneumonia:A multivariate analysis [J]. JAMA 1993,270(16):1965-1970.
[81]Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients:a randomised trial [J]. Lancet 1999, 354(9193):1851-1858.
[82]蔡卫新,苏丹.机械通气管路中冷凝水的管理[J].中华护理杂志,2010,45(6)：552-553.
[83]Kollef MH, Afessa B, Anzueto A et al. Silvercoated endotracheal tubes and incidence of ventilator-associated pneumonia:the nascent randomized trial [J]. JAMA 2008,300(7),805-813.
[84]Augustyn B. Ventilator-Associated Pneumonia Risk Factors and Prevention [J]. Critical Care Nurse,2007; 27:32-39
[85]Van Nieuwenhoven CA, Buskens E, Bergmans DC, van Tiel FH, Ramsay G, Bonten MJ. Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units [J]. Critical Care Medicine,2004,32(1):126-130.
[86]Lorente L., Blot S., Rello J. Evidence on measures for the prevention of ventilator-associated pneumonia [J]. Eur Respir J 2007; 30:1193-1207.