Kochar Sandeep, Sheard Timothy, Sharma Roopali, Hui Alan, Tolentino Elaine, Allen George, Landman David, Bratu Simona, Augenbraun Michael, Quale John
Infectious Diseases Division, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
Infect Control Hosp Epidemiol. 2009 May;30(5):447-52. doi: 10.1086/596734.
To assess the effect of enhanced infection control measures with screening for gastrointestinal colonization on limiting the spread of carbapenem-resistant Klebsiella pneumoniae in a New York City hospital endemic for this pathogen.
Retrospective observational study with pre- and postinterventional phases.
Beginning in 2006, a comprehensive infection control program was instituted in a 10-bed medical and surgical intensive care unit at a university-based medical center. In addition to being placed in contact isolation, all patients colonized or infected with carbapenem-resistant gram-negative bacilli, vancomycin-resistant Enterococcus, or methicillin-resistant Staphylococcus aureus were cohorted to one end of the unit. Improved decontamination of hands and environmental surfaces was encouraged. In addition, routine rectal surveillance cultures were screened for the presence of carbapenem-resistant pathogens. The number of patients per quarter with clinical cultures positive for carbapenem-resistant K. pneumoniae was compared during the approximately 2-year periods before and after the intervention.
The mean number (+/-SD) of new patients per 1,000 patient-days per quarter with cultures yielding carbapenem-resistant K. pneumoniae decreased from 9.7 +/- 2.2 before the intervention to 3.7 +/- 1.6 after the intervention (P < .001). There was no change in the mean number of patient-days or the mean number of patients per quarter with cultures yielding methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, or carbapenem-resistant Acinetobacter baumannii or Pseudomonas aeruginosa after the intervention. There was no association between antibiotic usage patterns and carbapenem-resistant K. pneumoniae.
The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbapenemase KPC were endemic.
评估加强感染控制措施并筛查胃肠道定植情况对限制耐碳青霉烯类肺炎克雷伯菌在纽约市一家对此病原体呈地方性流行的医院内传播的效果。
具有干预前和干预后阶段的回顾性观察性研究。
从2006年开始，在一家大学医学中心的一个拥有10张床位的内科和外科重症监护病房实施了一项全面的感染控制计划。除了进行接触隔离外，所有定植或感染耐碳青霉烯类革兰阴性杆菌、耐万古霉素肠球菌或耐甲氧西林金黄色葡萄球菌的患者被集中安置在病房的一端。鼓励加强手部和环境表面的消毒。此外，对常规直肠监测培养物进行耐碳青霉烯类病原体筛查。比较干预前后约2年期间每季度临床培养出耐碳青霉烯类肺炎克雷伯菌阳性的患者数量。
每1000患者日每季度培养出耐碳青霉烯类肺炎克雷伯菌的新患者平均数量（±标准差）从干预前的9.7±2.2降至干预后的3.7±1.6（P<.001）。干预后，每季度培养出耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、耐碳青霉烯类鲍曼不动杆菌或铜绿假单胞菌的患者日平均数量及患者平均数量均无变化。抗生素使用模式与耐碳青霉烯类肺炎克雷伯菌之间无关联。
将强化感染控制措施与常规直肠监测培养相结合的综合干预措施有助于降低在一家重症监护病房中耐碳青霉烯类肺炎克雷伯菌的发病率，该病房中产生碳青霉烯酶KPC的菌株呈地方性流行。
