García-San Vicente Blanca, Canut Andrés, Labora Alicia, Otazua Maritxu, Corral Esther
Servicio de Laboratorio, Hospital Santiago Apóstol, Osakidetza-Servicio Vasco de Salud, Vitoria, Alava, Spain.
Enferm Infecc Microbiol Clin. 2010 Feb;28(2):75-81. doi: 10.1016/j.eimc.2009.03.005. Epub 2009 Jul 25.
This study determines the workload and cost of implementing selective digestive decontamination in the microbiology laboratory, and reports the impact on microbial flora and bacterial resistance trends in the intensive care unit (ICU).
The total microbiological workload and cost were quantified, as well as the part charged to the petitioning service, in the year before and the year after introducing the procedure. Changes in microbial flora were evaluated and bacterial resistance trends were analyzed over 12 years in 21 sentinel antimicrobial/microorganism combinations.
The workload ascribed to the ICU increased by 10% and cost increased by 1.8% in the period after introduction of the procedure (non-significant differences). The increased workload resulting from epidemiological surveillance cultures was compensated by significant reductions in quantitative endotracheal aspirate cultures, blood cultures, exudate cultures, identification tests with antibiograms, and serologies. The procedure has been associated with a significant decrease in Acinetobacter isolates and a significant increase in Enterococcus. Three significant trends of increased resistance were detected, all of them in Pseudomonas aeruginosa (imipenem, tobramycin, and ciprofloxacin).
In our hospital, implementation of selective digestive decontamination did not cause a significant increase in the workload or costs in the microbiology laboratory. Selective digestive decontamination was associated with a significant decrease in Acinetobacter, an increase in Enterococcus, and higher resistance to imipenem, tobramycin and ciprofloxacin in P. aeruginosa.
本研究确定了在微生物实验室实施选择性消化道去污的工作量和成本，并报告了其对重症监护病房（ICU）微生物菌群和细菌耐药性趋势的影响。
对引入该程序前一年和后一年的微生物总工作量、成本以及向申请科室收取的费用进行量化。评估微生物菌群的变化，并对21种哨兵抗菌药物/微生物组合在12年中的细菌耐药性趋势进行分析。
引入该程序后，分配给ICU的工作量增加了10%，成本增加了1.8%（差异不显著）。流行病学监测培养导致的工作量增加被气管内吸引物定量培养、血培养、渗出液培养、药敏鉴定试验和血清学检查的显著减少所抵消。该程序与不动杆菌分离株显著减少和肠球菌显著增加有关。检测到三种耐药性增加的显著趋势，均出现在铜绿假单胞菌中（亚胺培南、妥布霉素和环丙沙星）。
在我们医院，实施选择性消化道去污并未导致微生物实验室的工作量或成本显著增加。选择性消化道去污与不动杆菌显著减少、肠球菌增加以及铜绿假单胞菌对亚胺培南、妥布霉素和环丙沙星的耐药性增加有关。
