Eveillard M, Eb F, Tramier B, Schmit J L, Lescure F X, Biendo M, Canarelli B, Daoudi F, Laurans G, Rousseau F, Thomas D
Department of Bacteriology, Hygiene and Infection Control, Hôpital Nord, Amiens, France.
J Hosp Infect. 2001 Feb;47(2):116-24. doi: 10.1053/jhin.2000.0877.
From February 1999 to January 2000, a control programme to prevent the spread multi-resistant bacteria (MRB) was implemented in a French teaching hospital. This programme focused on methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL), and was based on the application of barrier precautions (washing hands with antiseptic soaps, wearing disposable gloves and gowns, identifying MRB carriers). No changes in antibiotic policy occurred during the year. Our aim was to conduct an evaluation of this programme by measuring incidence rates. Concurrently, the effect of barrier precautions was estimated in an indirect way, by documenting the availability of barrier precautions in MRB carriers' rooms and by analysing the monthly correlation between the supply of such material and the theoretical cumulated length of MRB carriers' isolation in six randomized wards. All MRB isolated in hospitalized patients were recorded, and differentiated between acquisition in our hospital or from elsewhere. For the analysis of trends, the year was divided in three periods of four months. Over the year, the global MRB incidence was 1.26 per 1000 patient-days (PD) [95% confidence interval (95%CI)=1.16-1.36]. The MRSA incidence was 0.89 per 1000 PD (95%CI=0.81- 0.97) and the ESBL incidence was 0.38 per 1000 PD (95% CI=0.33-0.43). The MRB incidence decreased significantly in all types of specialties except for surgical wards. The incidence decreased by 17.9% for MRSA, 54.9% for ESBL and 34.8% for both MRB. Concurrently, the proportion of strains acquired in our hospital decreased for MRSA (P for trend > or = 0.05) and ESBL (P for trend > or = 0.01), whereas the incidence of imported strains increased slightly. The proportion of multiresistant strains in S. aureus (36.8%) and Enterobacter aerogenes (37.0%) remained similar throughout the year. Thus, the decrease of the incidence concerned both resistant and susceptible strains. The availability of antiseptic soaps increased significantly (P for trend > or = 0.01). The amount of antiseptic soap ordered and the theoretical lengths of isolation were correlated on a monthly basis (Spearman coefficient = 0.72; P > or = 0.02). These results shows the efficacy of such a programme of MRB containment in a large hospital, provided barrier nursing is instigated, together with the availability of such material as antiseptic soap, to allow implementation.
1999年2月至2000年1月，法国一家教学医院实施了一项预防多重耐药菌（MRB）传播的控制计划。该计划主要针对耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌，基于实施屏障预防措施（用抗菌肥皂洗手、佩戴一次性手套和隔离衣、识别MRB携带者）。这一年抗生素政策未发生变化。我们的目的是通过测量发病率来评估该计划。同时，通过记录MRB携带者病房中屏障预防措施的可用性，并分析六个随机病房中此类物资供应与MRB携带者理论累计隔离时长之间的月度相关性，以间接方式评估屏障预防措施的效果。记录住院患者中分离出的所有MRB，并区分是在本院获得还是从其他地方获得。为分析趋势，将这一年分为三个四个月的时间段。全年中，MRB总体发病率为每1000患者日（PD）1.26例[95%置信区间（95%CI）=1.16 - 1.36]。MRSA发病率为每1000 PD 0.89例（95%CI = 0.81 - 0.97），ESBL发病率为每1000 PD 0.38例（95%CI = 0.33 - 0.43）。除外科病房外，所有专科的MRB发病率均显著下降。MRSA发病率下降了17.9%，ESBL下降了54.9%，MRB总体下降了34.8%。同时，本院获得菌株的比例在MRSA方面下降（趋势P≥0.05），在ESBL方面下降（趋势P≥0.01），而输入菌株的发病率略有上升。金黄色葡萄球菌（36.8%）和产气肠杆菌（37.0%）中多重耐药菌株的比例全年保持相似。因此，发病率的下降涉及耐药菌株和敏感菌株。抗菌肥皂的可用性显著增加（趋势P≥0.01）。每月订购的抗菌肥皂量与理论隔离时长相关（Spearman系数 = 0.72；P≥0.02）。这些结果表明，在一家大型医院中，这样的MRB控制计划是有效的，但前提是要推行屏障护理，并提供抗菌肥皂等物资以确保实施。
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