ICU菌血症感染与相关死亡率的十年调查研究

David

Journal of Hospital Infection
Volume 69, Issue 1, May 2008, Pages 56-61
Estimates of the rate of acquisition of bacteraemia and associated excess mortality in a general intensive care unit: a 10 year study
ICU菌血症感染与相关死亡率的十年调查研究
D.S. Thompson, a,

aMedway Maritime Hospital, Gillingham, Kent, UK


Received 1 August 2007;  accepted 9 January 2008.  Available online 18 March 2008.

Summary
During a period of 10 years, 293 of 4270 admissions to the general intensive care unit (ICU) at Medway Maritime Hospital had 356 bacteraemias due to one of 14 microorganisms. Incidence of bacteraemia was least on the third day after admission, significantly greater on the fifth day and stable thereafter. From the fifth day the acquisition rate was 18.9 (16.5–21.3)/1000 bed-days, lower in those with an initial Acute Physiological Assessment and Chronic Health Evaluation II score (APII) <18, or admitted from the emergency room. A total of 1395 patients with no positive cultures in the first four days stayed in ICU for ≥5 days, and 204 subsequently had one or more bacteraemias. Hospital mortality in these patients was 45.6% (38.8–52.4), greater than in those with similar APII but sterile cultures [relative risk (RR): 1.30 (1.04–1.63) and matched controls, RR: 1.33 (1.09–1.63)]. Observed mortality was greater than predicted only in bacteraemic patients [RR: 1.31 (1.03–1.67)]. ICU-acquired bacteraemia was associated with an approximate additional absolute mortality of 11% contributing 0.5% to the 29.9% hospital mortality of all ICU admissions, 1.6% to the 34.6% of those staying ≥5 days, and 5.6% to the 35.9% of those remaining >24 days.

Keywords: Bacteraemia; Intensive care unit; Nosocomial infection

David

Journal of Hospital Infection
Volume 69, Issue 1, May 2008, Pages 39-45
Long-term outcomes following infection with meticillin-resistant or meticillin-susceptible Staphylococcus aureus
MRSA与MSSA感染后长期结果的差别
S. Haessler, a, , T. Mackenziea and K.B. Kirklanda

aDartmouth–Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire, USA


Received 3 July 2007;  accepted 7 January 2008.  Available online 19 March 2008.

Summary
Staphylococcus aureus (SA) is becoming increasingly resistant to antibiotics in hospitals and the community. Long-term outcomes following susceptible and resistant SA infection have not been studied. We performed a retrospective matched pair analysis of all patients with positive culture for meticillin-resistant SA (MRSA) or meticillin-susceptible SA (MSSA) from any site to assess the outcomes of infection. Data were collected for length of hospitalisation and in-hospital mortality, as well as longer-term outcomes including all-cause mortality, number of rehospitalisations and subsequent cultures for SA during the year following infection. Twelve months after their initial SA infection, 42% of patients were dead. There were no differences between the groups in short-term mortality, length of hospitalisation, number of subsequent hospitalisations and cultures for SA during the year following infection. Following discharge, however, MRSA infection was associated with higher mortality than MSSA at three months (32% vs 18% P = 0.02), six months (42% vs 22% P = 0.002) and 12 months (51% vs 32% P = 0.005). In conclusion, SA infection is associated with a high one-year all-cause mortality. Most deaths occur after discharge. The likelihood of dying during the year following infection is higher for patients with MRSA infection than for those with MSSA infection.

Keywords: Staphylococcus aureus; Meticillin-resistant; Outcomes

右手心

前段时间，我院ICU有很大问题，这篇文章应该给他们主任看下。。。

manzung0202

謝謝分享~ 10年的數據值得參考