美国医院获得性感染罹患率的改变

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美国医院获得性感染罹患率的改变
2018年11月17日
ORIGINAL ARTICLE
Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals
Shelley S. Magill, Erin O’Leary, Sarah J. Janelle, et al
N Engl J Med 2018; 379:1732-1744
DOI: 10.1056/NEJMoa1801550
Abstract
BACKGROUND 背景
A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care–associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care–associated infections during a period of national attention to the prevention of such infections.

2011年美国进行的一项点患病率调查显示，4%的住院患者发生医院获得性感染。2015年，我们重复了这项调查，以评估在全国关注感染预防阶段医院获得性感染患病率的改变。

METHODS 方法
At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care–associated infections. We compared the percentages of patients with health care–associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care–associated infections.

在10个州的新出现感染计划的中心，我们在每个区域至多纳入25家医院，优先选择参加过2011年调查的医院。每所医院选择1天，对随机确定的患者进行评估。经过培训的人员根据2011年医院获得性感染定义查询病历。我们比较了医院获得性感染患者比例，进行多因素对数二项回归模型分析，以评估调查年份与医院获得性感染风险的相关性。

RESULTS 结果
In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care–associated infections in 2015 (394 patients [3.2%; 95% confidence interval {CI}, 2.9 to 3.5]) than in 2011 (452 [4.0%; 95% CI, 3.7 to 4.4]) (P<0.001), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile [now Clostridioides difficile]), and surgical-site infections were the most common health care–associated infections. Patients’ risk of having a health care–associated infection was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 to 0.95; P=0.005), after adjustment for age, presence of devices, days from admission to survey, and status of being in a large hospital.

在2015年，共有199所医院的 12,299 名患者参加调查。与此相比，2011年有183所医院的 11,282 名患者参加。与2011年(452 [4.0%; 95% CI, 3.7 to 4.4])相比，2015年更少患者（394名患者 [3.2%; 95% 可信区间 {CI}, 2.9 to 3.5]）发生医院获得性感染(P<0.001)，主要原因在于手术部位感染及泌尿系感染率降低。肺炎、胃肠道感染（多数为难辨梭状芽孢杆菌）及手术部位感染是最常见的医院获得性感染。对年龄、各种装置、入院至调查时间间隔以及医院规模进行校正后，与2011年相比，2015年患者罹患医院获得性感染的风险降低16%（比数比0.84; 95% CI, 0.74 to 0.95; P=0.005）。

   

CONCLUSIONS 结论
The prevalence of health care–associated infections was lower in 2015 than in 2011. To continue to make progress in the prevention of such infections, prevention strategies against C. difficile infection and pneumonia should be augmented.

2015年医院获得性感染罹患率低于2011年。为进一步预防感染，应当加强难辨梭状芽孢杆菌及肺炎的预防措施。

(Funded by the Centers for Disease Control and Prevention.)

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