일개 종합병원 중환자실의 병원성 혈류감염에 관한 연구
Nosocomial Bloodstream Infection in Intensive Care Unit in a General Hospital
역학 및 보건정보학과
종합병원 중환자실 병원성 혈류감염;
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Objectives : Despite of the development of recent medical technology, bloodstream infection still has significant influences on mortality and morbidity of admitted patients. The bloodstream infection has the second most frequent infection site, representing 17% of all infections. Especially bloodstream infection in intensive care unit has higher infection rate than general ward. Because of patients in intensive care unit, have higher disease severity and the frequency of the exposure to invasive device. Approximately 90% of primary bloodstream infections occur in patients with intravascular devices, especially central lines and these represent the most powerful risk factors for bloodstream infections. Methods : This study was carried out with the patients who met the definition of the bloodstream infection(CDC, 1998) that showed the positive result through the blood culture for the patients with fever after 48hours the hospitalization in a general hospital in Pundang with 633 beds from march 2002 to February 2003. This study was carried out through medical record review. The incidence rate of the loodstream infection by age, sex, underlying diseases and type of intensive care units was measured. Statistical analysis were performed using SPSS 10.0. Results : In the incidence rate of the bloodstream infection were 76.7 in 1,000 admitted patients, 7.0 in 1,000 admitted patients days and 32.1 in 1,000 patients with central lines, 3.2 in 1,000 central-line days. In the incidence rates of the bloodstream infection by type of intensive care unit showed MICU, SICU, 10.1, 2.9 in 1,000 admitted patients days. The causal microbes of the bloodstream infection were Coagulase-negative staphylococci, Methicillin -resistant staphylococcus aureus, Enterococcus faecalis, Streptoccus spp, Klebsiella pneumoniae, Escherichia coli, Candida albicans in 12 cases(35.3%), 8 cases(23.5%), 5 cases(14.7%), 5 cases(14.7%), 2 cases(5.9%), 1 cases(2.9%) and 1 cases(2.9%). Also, causal microbes of the catheter related bloodstream infection were Coagulase-negative staphylococci, Methicillin-resistant staphylococcus aureus in 3 cases(50.0%), 3 cases(50.0%). Conclusions : This study was showed the type of ICU and lengh of stay as a risk factor of the bloodstream infection. Patients with peripheral line was showed to decrease risk of the bloodstream infection. It was because that most of patients without peripherial line had central line and arterial line. Central line of invasive device was not confirmed as a risk factor of the bloodstream infection. For these reasons, further studies of primary bloodstream infection in intensive care unit are recommended.