| Citation: |
SHI Zhan, CHANG Zhigang. Hospital Acquired Infections and Non-Hospital Acquired Infections in the Department of Critical Care Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(3): 489-497. DOI: 10.12290/xhyxzz.2024-0119
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Patients with infections in the department of critical care medicine have complex sources and diverse sites of infection, which may be associated with multiple pathogenic bacteria and have a high rate of drug resistance, posing a significant challenge to clinical diagnosis and treatment. Infections in the department of critical care medicine can be divided into two types: hospital acquired infections and non-hospital acquired infections, with significant differences in clinical characteristics between the two. This article discusses the relevant concepts, risk factors, pathogenesis, and common characteristics of severe infections such as bloodstream infections, pulmonary infections, intra-abdominal infections, and intracranial infections, as well as diagnostic and treatment plans and prevention and control strategies from the perspectives of hospital acquired and non-hospital acquired infections, aiming to provide valuable guidance for the clinical management of critically ill patients.
| [1] |
翟茜, 胡波, 郑瑞强, 等. 重症感染诊疗流程[J]. 中华重症医学电子杂志, 2017, 3(2): 127-132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYD201702010.htm
Zhai Q, Hu B, Zheng R Q, et al. Protolized diagnosis and treatment in severe infection[J]. Chin J Crit Care Intensive Care Med, 2017, 3(2): 127-132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYD201702010.htm
|
| [2] |
Lamontagne F, Harrison D A, Rowan K M. qSOFA for identifying sepsis among patients with infection[J]. JAMA, 2017, 317(3): 267-268. DOI: 10.1001/jama.2016.19684
|
| [3] |
Vincent J L, Moreno R, Takala J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine[J]. Intensive Care Med, 1996, 22(7): 707-710. DOI: 10.1007/BF01709751
|
| [4] |
中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J]. 中华内科杂志, 2013, 52(6): 524-543. DOI: 10.3760/cma.j.issn.0578-1426.2013.06.024
Critical Care Medicine Branch of the Chinese Medical Association. Diagnosis, prevention, and treatment guidelines for ventilator associated pneumonia (2013)[J]. Chin J Intern Med, 2013, 52(6): 524-543. DOI: 10.3760/cma.j.issn.0578-1426.2013.06.024
|
| [5] |
中华医学会外科学分会, 中国研究型医院学会感染性疾病循证与转化专业委员会, 中华外科杂志编辑部. 外科常见腹腔感染多学科诊治专家共识[J]. 中华外科杂志, 2021, 59(3): 161-178.
Chinese Society of Surgery of Chinese Medical Association, Infectious Diseases Society for Evidence-based and Translational Medicine of Chinese Research Hospital Association, Editorial Board of Chinese Journal of Surgery. Expert consensus on multidisciplinary management of intra-abdominal infections[J]. Chin J Surg, 2021, 59(3): 161-178.
|
| [6] |
Magill S S, Edwards J R, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections[J]. N Engl J Med, 2014, 370(13): 1198-1208. DOI: 10.1056/NEJMoa1306801
|
| [7] |
中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4): 255-280. DOI: 10.3760/cma.j.issn.1001-0939.2018.04.006
Infectious Disease Group of the Respiratory Disease Branch of the Chinese Medical Association. Diagnosis and treatment guidelines for Chinese adult hospital acquired pneumonia and ventilator associated pneumonia (2018 edition)[J]. Chin J Tuberc Respir Dis, 2018, 41(4): 255-280. DOI: 10.3760/cma.j.issn.1001-0939.2018.04.006
|
| [8] |
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associ-ated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4): 388-416. DOI: 10.1164/rccm.200405-644ST
|
| [9] |
Kalil A C, Metersky M L, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5): e61-e111. DOI: 10.1093/cid/ciw353
|
| [10] |
Kreitmann L, Helms J, Martin-Loeches I, et al. ICU-acquired infections in immunocompromised patients[J]. Intensive Care Med, 2024, 50(3): 332-349. DOI: 10.1007/s00134-023-07295-2
|
| [11] |
Akrami K, Sweeney D A. The microbiome of the critically ill patient[J]. Curr Opin Crit Care, 2018, 24(1): 49-54. DOI: 10.1097/MCC.0000000000000469
|
| [12] |
Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4): 569-580. DOI: 10.1136/gutjnl-2016-313017
|
| [13] |
中华预防医学会医院感染控制分会, 中华医学会感染病学分会, 中国医院协会医院感染管理专业委员会, 等. 中国碳青霉烯耐药革兰阴性杆菌(CRO) 感染预防与控制技术指引[J]. 中华医院感染学杂志, 2019, 29(13): 2075-2080. https://www.cnki.com.cn/Article/CJFDTOTAL-WSWG202002001.htm
Hospital Infection Control Branch of the Chinese Association of Preventive Medicine, Infectious Disease Branch of the Chinese Medical Association, Hospital Infection Management Professional Committee of China Hospital Association, et al. Technical guidelines for prevention and control of carbapenem- resistant gram-negative bacilli infection in China[J]. Chin J Nosocomiol, 2019, 29(13): 2075-2080. https://www.cnki.com.cn/Article/CJFDTOTAL-WSWG202002001.htm
|
| [14] |
陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识[J]. 中国医药科学, 2012, 2(8): 3-8. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX201208006.htm
Chen B Y, He L X, Hu B J, et al. Expert consensus on the diagnosis, treatment, and prevention of Acinetobacter baumannii infection in China[J]. China Med Pharm, 2012, 2(8): 3-8. https://www.cnki.com.cn/Article/CJFDTOTAL-GYKX201208006.htm
|
| [15] |
Azoulay E, Russell L, Van De Louw A, et al. Diagnosis of severe respiratory infections in immunocompromised patients[J]. Intensive Care Med, 2020, 46(2): 298-314. DOI: 10.1007/s00134-019-05906-5
|
| [16] |
Lionakis M S, Netea M G. Candida and host determinants of susceptibility to invasive candidiasis[J]. PLoS Pathog, 2013, 9(1): e1003079. DOI: 10.1371/journal.ppat.1003079
|
| [17] |
Roblot F, Godet C, Le Moal G, et al. Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients[J]. Eur J Clin Microbiol Infect Dis, 2002, 21(7): 523-531. DOI: 10.1007/s10096-002-0758-5
|
| [18] |
Timsit J F, Ruppé E, Barbier F, et al. Bloodstream infections in critically ill patients: an expert statement[J]. Intensive Care Med, 2020, 46(2): 266-284. DOI: 10.1007/s00134-020-05950-6
|
| [19] |
中国医师协会急诊医师分会, 中华医学会急诊医学分会, 中国急诊专科医联体, 等. 急诊成人细菌性感染诊疗专家共识[J]. 中国急救医学, 2020, 40(11): 1029-1035. DOI: 10.3969/j.issn.1002-1949.2020.11.002
Emergency Physicians Branch of the Chinese Medical Association, Emergency Medicine Branch of the Chinese Medical Association, China Emergency Medical Association, et al. Consensus among emergency diagnosis and treatment experts for adult bacterial infections[J]. Chin J Crit Care Med, 2020, 40(11): 1029-1035. DOI: 10.3969/j.issn.1002-1949.2020.11.002
|
| [20] |
中华医学会呼吸病学分会感染学组. 铜绿假单胞菌下呼吸道感染诊治专家共识[J]. 中华结核和呼吸杂志, 2014, 37(1): 9-15.
Infectious Disease Group of the Respiratory Disease Branch of the Chinese Medical Association. Expert consensus on the diagnosis and treatment of lower respiratory tract infections caused by Pseudomonas aeruginosa[J]. Chin J Tuberc Respir Dis, 2014, 37(1): 9-15.
|
| [21] |
Newman N, Issa A, Greenberg D, et al. Central venous catheter-associated bloodstream infections[J]. Pediatr Blood Cancer, 2012, 59(2): 410-414. DOI: 10.1002/pbc.24135
|
| [22] |
杨祖耀, 詹思延, 王波, 等. 中国血流感染住院病死率的系统评价和meta分析[J]. 北京大学学报(医学版), 2010, 42(3): 304-307. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201003016.htm
Yang Z Y, Zhan S Y, Wang B, et al. Fatality and secular trend of bloodstream infections during hospitalization in China: a systematic review and meta-analysis[J]. J Peking Univ Health Sci, 2010, 42(3): 304-307. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB201003016.htm
|
| [23] |
Gouel-Cheron A, Swihart B J, Warner S, et al. Epidemio-logy of ICU-onset bloodstream infection: prevalence, pathogens, and risk factors among 150, 948 ICU patients at 85 U.S. hospitals[J]. Crit Care Med, 2022, 50(12): 1725-1736.
|
| [24] |
De Sousa T, Hébraud M, Dapkevicius M L N E, et al. Genomic and metabolic characteristics of the pathogenicity in Pseudomonas aeruginosa[J]. Int J Mol Sci, 2021, 22(23): 12892.
|
| [25] |
Pappas P G, Kauffman C A, Andes D R, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4): e1-e50.
|
| [26] |
李琰冰, 陆旻雅, 肖盟, 等. 中国临床重要真菌监测的工作进展[J]. 中国合理用药探索, 2022, 19(8): 8-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYS202208002.htm
Li Y B, Lu M Y, Xiao M, et al. Progress of clinical important fungi surveillance in China[J]. Chin J Ration Drug Use, 2022, 19(8): 8-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYS202208002.htm
|
| [27] |
Han X D, Zhou F, Li H, et al. Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia[J]. BMC Infect Dis, 2018, 18(1): 192.
|
| [28] |
中华医学会急诊医学分会, 中国老年社区获得性肺炎急诊诊疗专家共识组. 中国老年社区获得性肺炎急诊诊疗专家共识[J]. 中华急诊医学杂志, 2023, 32(10): 1319-1327.
Emergency Medicine Branch of the Chinese Medical Association, Consensus group of emergency diagnosis and treatment experts for community-acquired pneumonia in the elderly in China. Consensus among emergency diagnosis and treatment experts for community-acquired pneumonia in the elderly in China[J]. Chin J Emerg Med, 2023, 32(10): 1319-1327.
|
| [29] |
Clementi N, Ghosh S, De Santis M, et al. Viral respiratory pathogens and lung injury[J]. Clin Microbiol Rev, 2021, 34(3): e00103-20.
|
| [30] |
Sakr Y, Moreira C L, Rhodes A, et al. The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the extended prevalence of infection in intensive care study[J]. Crit Care Med, 2015, 43(3): 519-526.
|
| [31] |
Kumar V. Pulmonary innate immune response determines the outcome of inflammation during pneumonia and sepsis-associated acute lung injury[J]. Front Immunol, 2020, 11: 1722.
|
| [32] |
卢昆, 耿仕涛, 唐士凯, 等. 术后腹腔感染的研究进展[J]. 中国普外基础与临床杂志, 2021, 28(4): 530-536. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202104020.htm
Lu K, Geng S T, Tang S K, et al. Research progress of postoperative intra-abdominal infection[J]. Chin J Bas Clin Gen Surg, 2021, 28(4): 530-536. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202104020.htm
|
| [33] |
Weigelt J A. Empiric treatment options in the management of complicated intra-abdominal infections[J]. Cleve Clin J Med, 2007, 74(Suppl 4): S29-S37.
|
| [34] |
Lin S Y, Huang C H, Ko W C, et al. Recent developments in antibiotic agents for the treatment of complicated intra-abdominal infections[J]. Expert Opin Pharmacother, 2016, 17(3): 339-354.
|
| [35] |
World Health Organization. The burden of health care-associated infection worldwide[EB/OL]. [2024-02-27]. https://www.who.int/news-room/feature-stories/detail/the-burden-of-health-care-associated-infection-worldwide.
|
| [36] |
中华医学会外科学分会外科感染与重症医学学组, 中国医师协会外科医师分会肠瘘外科医师专业委员会. 中国手术部位感染预防指南[J]. 中华胃肠外科杂志, 2019, 22(4): 301-314.
Surgical Infection and Critical Care Medicine Group of the Chinese Medical Association's Surgery Branch, The Professional Committee of Intestinal Fistula Surgeons of the Surgical Branch of the Chinese Medical Association. Chinese guideline for the prevention of surgical site infection[J]. Chin J Gastrointest Surg, 2019, 22(4): 301-314.
|
| [37] |
Brouwer M C, Van De Beek D. Epidemiology of community-acquired bacterial meningitis[J]. Curr Opin Infect Dis, 2018, 31(1): 78-84.
|
| [38] |
Figueiredo A H A, Brouwer M C, Van De Beek D. Acute community-acquired bacterial meningitis[J]. Neurol Clin, 2018, 36(4): 809-820.
|
| [39] |
Tunkel A R, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis[J]. Clin Infect Dis, 2017, 64(6): e34-e65.
|
| [40] |
Van De Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis[J]. Clin Microbiol Infect, 2016, 22(Suppl 3): S37-S62.
|
| [41] |
Tunkel A R, Hartman B J, Kaplan S L, et al. Practice guidelines for the management of bacterial meningitis[J]. Clin Infect Dis, 2004, 39(9): 1267-1284.
|
| [42] |
Chen Y, Liu L. The treatment of nosocomial meningitis and brain abscess by carbapenem-resistant Klebsiella pneumonia[J]. Br J Neurosurg, 2023, 37(4): 634-636.
|
| [43] |
Centers for Disease Control and Prevention (CDC). Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities[J]. MMWR Morb Mortal Wkly Rep, 2009, 58(10): 256-260.
|
| [44] |
Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control programme[J]. Lancet, 2000, 356(9238): 1307-1312.
|
| [45] |
Peters A, Schmid M N, Parneix P, et al. Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: a systematic review[J]. Antimicrob Resist Infect Control, 2022, 11(1): 38.
|
| [46] |
Tacconelli E. Screening and isolation for infection control[J]. J Hosp Infect, 2009, 73(4): 371-377.
|
| [47] |
Friedman N D, Carmeli Y, Walton A L, et al. Carbapenem-resistant enterobacteriaceae: a strategic roadmap for infection control[J]. Infect Control Hosp Epidemiol, 2017, 38(5): 580-594.
|
| [48] |
Hammond N E, Myburgh J, Seppelt I, et al. Association between selective decontamination of the digestive tract and in-hospital mortality in intensive care unit patients receiving mechanical ventilation: a systematic review and meta-analysis[J]. JAMA, 2022, 328(19): 1922-1934.
|
| [49] |
The SuDDICU Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group. Effect of selective decontamination of the digestive tract on hospital mortality in critically ill patients receiving mechanical ventilation: a randomized clinical trial[J]. JAMA, 2022, 328(19): 1911-1921.
|
| [50] |
Timsit J F, Lipman J, Bassetti M. Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU[J]. Intensive Care Med, 2020, 46(5): 1039-1042.
|
| [51] |
Rello J, Lode H, Cornaglia G, et al. A European care bundle for prevention of ventilator-associated pneumonia[J]. Intensive Care Med, 2010, 36(5): 773-780.
|
| [52] |
Hellyer T P, Ewan V, Wilson P, et al. The intensive care society recommended bundle of interventions for the preven-tion of ventilator-associated pneumonia[J]. J Intensive Care Soc, 2016, 17(3): 238-243.
|
| [53] |
Selby L M, Rupp M E, Cawcutt K A. Prevention of central-line associated bloodstream infections: 2021 update[J]. Infect Dis Clin North Am, 2021, 35(4): 841-856.
|
| [54] |
Bion J, Richardson A, Hibbert P, et al. 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England[J]. BMJ Qual Saf, 2013, 22(2): 110-123.
|
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