2022年重症监护室（ICU）获得性医疗相关感染年度流行病学报告

Healthcare-associated infectionsacquired in intensive care units Annual Epidemiological Report for 2022 Key facts •In 2022, 9 802 of 100 277 patients (9.8%) staying in an intensive care unit (ICU) for more than two dayspresented with at least one of the ICU-acquired healthcare-associated infections (HAI) under surveillance(pneumonia, bloodstream infection or urinary tract infection).•Of all patients staying in an ICU for more than two days, 6% presented with pneumonia, 4% withbloodstream infection (BSI) and 3% with urinary tract infection (UTI).•Eighty-three percent of pneumonia episodes were associated with intubation, 43% of BSI episodes werecatheter-related, and 95% of UTI episodes were associated with presence of a urinary catheter. •The most frequently isolated microorganism wasPseudomonas aeruginosa in ICU-acquired pneumoniaepisodes, coagulase-negative staphylococci in ICU-acquired BSIs, andEscherichia coli in ICU-acquired UTIs.•Antimicrobial use was empirical in 55% of ‘days of therapy’ (DOTs), directed in 34% of DOTs and Introduction Intensive care units (ICUs) are the hospital wards with the highest prevalence of healthcare-associated infections(HAIs). The majority of HAIs in ICUs are associated with the use of invasive devices (e.g. endotracheal tubes,vascular and urinary catheters), and a significant proportion of these HAIs are considered preventable. Moreover,the burden of antimicrobial resistance (AMR) is high in ICUs due to the severity of the clinical condition of the Methods This report is based on data for 2022 retrieved from EpiPulse on 20 February 2025. EpiPulse is the Europeansurveillance portal for infectious diseases. European Union and European Economic Area (EU/EEA) countriescontribute to the system by uploading their infectious disease surveillance data at regular intervals. For a detailed description of methods used to produce this report, please refer to the Methods chapter [1].An overview of the national surveillance systems is available online [2]. A patient-based (‘standard’) protocol and a unit-based (‘light’) protocol are used for European surveillance of HAIsacquired in ICUs. The patient-based protocol is used to collect data for all patients, regardless of infection,including information on risk factors, to allow risk-adjusted inter-hospital comparisons. With the unit-based Inclusion criteria, risk factors and case definitions of ICU-acquired HAIs are described in detail in the protocol [3].Infections occurring after 48 hours in the ICU are considered as ICU-acquired in both protocols. If the admissionday is counted as day 1, infections with onset from day 3 onwards should be reported. One record per HAI is The minimal requirement for surveillance of ICU-acquired HAIs is to include bloodstream infections (BSIs) andpneumonia. The collection of data on urinary tract infections (UTIs) and central venous catheter (CVC)-relatedinfections is optional. A case of pneumonia is defined in accordance with clinical criteria (X-ray, fever >38°C, leucocytosis >12 000 whiteblood cells (WBC)/mm3, purulent sputum) and further sub-categorised in five categories according to the level ofmicrobiological confirmation: PN1, minimally contaminated lower respiratory tract sample with quantitative culture(104colony-forming units (CFU)/ml for bronchoalveolar lavage, 103CFU/ml for protected brush samples or distalprotected aspirate); PN2, non-protected sample (endotracheal aspirate, ETA) with quantitative culture (106CFU/ml); PN3, alternative microbiological criteria (e.g. positive blood culture); PN4, sputum bacteriology or non- A BSI is defined as a positive blood culture of a recognised pathogen or the combination of clinical symptoms(fever >38°C, chills, hypotension) and two positive blood cultures of a common skin contaminant from twoseparate blood samples drawn within 48 hours. A UTI is defined as either (a) a microbiologically-confirmed symptomatic UTI (UTI-A) whereby the presence of atleast one sign or symptom coincides with a positive urine culture (defined as ≥105microorganisms per ml of urine,with no more than two species of microorganisms), or (b) a non-microbiologically-confirmed symptomatic UTI (UTI-B), whereby the presence of at least two signs or symptoms coincide with other criteria (e.g. a positivedipstick for leukocyte esterase and/or nitrate (see protocol for details of case definitions).A HAI was defined as device-associated when the relevant device was used (even intermittently) in the 48 hours(two days) before onset of infection. For countries performing surveillance of catheter-related infections (CRIs), amicrobiologically-confirmed central vascular catheter (CVC)-related BSI was defined as a BSI occurring 48 hoursbefore or after catheter removal, and a positive culture with the same microorganism of either (a) quantitative CVCculture ≥ 103CFU/ml or semi-quantitative CVC culture >15 CFU, or (b) quantitative blood culture ratio CVC bloodsample/peripheral blood