基于美国CDC/NHSN监测标准的某医院2021-2025年导尿管相关尿路感染的临床及病原学特征

Clinical and etiological characteristics of catheter-associated urinary tract infection from 2021 to 2025 in a hospital based on CDC/NHSN surveillance criteria

  • 摘要:
    目的 分析基于美国疾病控制与预防中心/国家医疗安全网络(CDC/NHSN)监测标准的导尿管相关尿路感染(CAUTI)的临床和病原学特征,为我国医院感染诊断标准的修订提供本土化参考。
    方法 收集2021年1月-2025年6月在广西医科大学第一附属医院住院期间发生CAUTI的患者临床资料,回顾性分析CAUTI的发病率、临床感染特点及病原学分布。
    结果 共监测留置导尿管患者107 875例,发生CAUTI 267例,发病率为0.65‰,较参照2010年中国《导尿管相关尿路感染预防与控制技术指南(试行)》监测的发病率(1.22‰)下降。19例CAUTI合并血流感染,合并血流感染发生率为7.12%。CAUTI发病率前三位的科室为康复科(6.21‰)、风湿免疫科(6.16‰)和肿瘤科(4.40‰)。尿标本共检出病原菌285株,其中革兰阴性菌184株(64.56%),革兰阳性菌101株(35.44%)。血标本共检出病原菌19株,以大肠埃希菌为主(9,47.37%)。留置导尿管7 d内血流感染的发生率最高(7/82, 8.54%)。尿检出2种病原菌和检出耐药菌主要发生在留置导尿管30 d后。
    结论 参照美国CDC/NHSN监测标准的CAUTI发病率较参照中国监测标准下降;美国CDC/NHSN关于CAUTI的医院感染监测标准和临床诊断标准的相关性有待进一步研究;肠球菌和大肠埃希菌成为CAUTI防控的主要病原菌。

     

    Abstract:
    OBJECTIVE To analyze the clinical and etiological characteristics of catheter-associated urinary tract infection (CAUTI) based on the surveillance criteria of the Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN), and provide localized evidence for revision of Chinese criteria for diagnosis of hospital-associated infections.
    METHODS The clinical data were collected from the patients who were diagnosed with CAUTI during hospitalization at the First Affiliated Hospital of Guangxi Medical University from Jan. 2021 to Jun. 2025. A retrospective analysis was conducted on the incidence rate, clinical infection features and etiological distribution of CAUTI.
    RESULTS A total of 107 875 catheterized patients were monitored, with 267 cases of CAUTI identified. The incidence rate was 0.65‰, showing a decrease compared to the rate (1.22‰) monitored under China′s 2010 "Technical Guidelines for Prevention and Control of Catheter-Associated Urinary Tract Infections (Trial)". Among them, 19 cases of CAUTI were complicated by bloodstream infection, with a bloodstream infection rate of 7.12%. The top three departments with the highest CAUTI incidence rates were rehabilitation department (6.21‰), rheumatology and immunology department (6.16‰) and oncology department (4.40‰). A total of 285 pathogenic bacteria were isolated from urine samples, including 184 gram-negative bacteria (64.56%) and 101 gram-positive bacteria (35.44%). A total of 19 pathogenic bacteria were detected from blood samples, predominantly Escherichia coli (9, 47.37%). The highest incidence rate of bloodstream infection occurred within 7 days of catheterization (7/82, 8.54%). The detection of two pathogenic bacteria or drug-resistant bacteria in urine primarily occurred after 30 days of catheterization.
    CONCLUSIONS The incidence rate of CAUTI under CDC/NHSN surveillance criteria is lower than that under Chinese surveillance standards. Further research is needed to explore the correlation between CDC/NHSN′s CAUTI hospital-associated infection surveillance criteria and clinical diagnostic standards. Enterococci and E. coli have emerged as the primary pathogenic bacteria for CAUTI prevention and control.

     

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