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NEJM:美国医疗机构卫生保健相关感染患病率的变化

发布日期:2018-11-06来源: NEJM官网发布人:感控雏鹰


背景

2011年在美国进行的一项流行病学调查显示,4%的住院患者有与健康相关的感染。我们在2015年重复了这项调查,以评估在国家注意预防此类感染期间医疗保健相关感染流行率的变化。

方法

我们在参与EIP(新发感染项目)的10个州分别招募了多达25家医院,优先考虑参与过2011年调查的医院。每个医院选择1天,随机抽取患者样本进行评估。接受过专业培训的工作人员使用2011年医疗保健相关感染的定义审查了医疗记录。我们比较了患者与医疗相关感染的百分比,并进行了多变量对数二项回归模型,以评估调查年与医疗相关感染风险之间的关联。

结果

2015年,共调查了199家医院的12299名患者,而2011年为183家医院的11282名患者。2015年,有少数患者患有与医疗相关的感染(394名患者[3.2%; 95%置信区间{CI}, 2.9至3.5])比2011年(452 [4.0%; 95%CI,3.7至4.4])(P <0.001),主要是由于手术部位和泌尿道感染的流行率降低。肺炎,胃肠道感染(大多数是由于艰难梭菌[现为艰难梭菌])和手术部位感染是最常见的保健相关感染。调整年龄、设备、自入院到调查的天数以及在大医院的状况后,2015年患者患有与医疗相关的感染风险比2011年降低16%(风险比,0.84; 95%CI,0.74至0.95; P = 0.005)。

结论

2015年医疗保健相关感染的流行率低于2011年。为了在预防此类感染方面继续取得进展,应加强针对艰难梭菌感染和肺炎的预防策略。

Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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

原文:Shelley S. Magill,et al.Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals.NEJM.2018. https://www.nejm.org/doi/full/10.1056/NEJMoa1801550

简译人:感控雏鹰