Department of Pharmaceutical Services, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
Surg Infect (Larchmt). 2011 Feb;12(1):15-25. doi: 10.1089/sur.2009.059. Epub 2010 Nov 22.
Resistance to broad-spectrum antibiotics by gram-negative organisms is increasing. Resistance demands more resource utilization and is associated with patient morbidity and death. We describe the implementation of infection reduction protocols, including antibiotic stewardship, and assess their impact on multi-drug-resistant (MDR) healthcare-acquired gram-negative infections.
Combined infection reduction and antibiotic stewardship protocols were implemented in the surgical and trauma intensive care units at Vanderbilt University Hospital beginning in 2002. The components of the program were: (1) Protocol-specific empiric and therapeutic antibiotics for healthcare-acquired infections; (2) surgical antibiotic prophylaxis protocols; and (3) quarterly rotation/limitation of dual antibiotic classes. Continuous healthcare-acquired infection surveillance was conducted by independent practitioners using National Heath Safety Network criteria. Linear regression analysis was used to estimate trends in MDR gram-negative healthcare-acquired infections.
A total of 1,794 gram-negative pathogens were isolated from healthcare-acquired infections during the eight-year observation period. The proportion of healthcare-acquired infections caused by MDR gram-negative pathogens decreased from 37.4% (2001) to 8.5% (2008), whereas the proportion of healthcare-acquired infections caused by pan-sensitive pathogens increased from 34.1% to 53.2%. The rate of total healthcare-associated infections per 1,000 patient-days that were caused by MDR gram-negative pathogens declined by -0.78 per year (95% confidence interval [CI] -1.28, -0.27). The observed rate of healthcare-acquired infections per 1,000 patient days attributable to specific MDR gram-negative pathogens decreased over time: Pseudomonas -0.14 per year (95% CI -0.20, -0.08), Acinetobacter-0.49 per year (95% CI -0.77, -0.22), and Enterobacteriaceae -0.14 per year (95% CI -0.26, -0.03).
Implementation of an antibiotic stewardship protocol as a component of an infection reduction campaign was associated with a decrease in resistant gram-negative healthcare-acquired infections in intensive care units. These results further support widespread implementation of such initiatives.
革兰氏阴性菌对广谱抗生素的耐药性正在增加。耐药性需要更多的资源利用，并与患者发病率和死亡率相关。我们描述了感染减少方案（包括抗生素管理）的实施，并评估了它们对多药耐药（MDR）医疗保健获得性革兰氏阴性感染的影响。
范德比尔特大学医院的外科和创伤重症监护病房从 2002 年开始实施联合感染减少和抗生素管理方案。该方案的组成部分包括：（1）针对医疗保健获得性感染的特定经验性和治疗性抗生素；（2）外科抗生素预防方案；（3）每季度轮换/限制双重抗生素类别。独立从业者使用国家卫生安全网络标准进行连续的医疗保健获得性感染监测。线性回归分析用于估计 MDR 革兰氏阴性医疗保健获得性感染的趋势。
在八年的观察期内，从医疗保健获得性感染中分离出了 1794 种革兰氏阴性病原体。MDR 革兰氏阴性病原体引起的医疗保健获得性感染的比例从 2001 年的 37.4%下降到 2008 年的 8.5%，而对 pan-sensitive 病原体引起的医疗保健获得性感染的比例从 34.1%增加到 53.2%。每 1000 个患者日引起的 MDR 革兰氏阴性病原体的总医疗相关感染率每年下降 0.78（95%置信区间 [CI] -1.28，-0.27）。特定 MDR 革兰氏阴性病原体引起的每 1000 个患者日医疗保健获得性感染的观察率随着时间的推移而降低：假单胞菌 -0.14 每年（95% CI -0.20，-0.08），不动杆菌 -0.49 每年（95% CI -0.77，-0.22），肠杆菌科 -0.14 每年（95% CI -0.26，-0.03）。
将抗生素管理方案作为感染减少活动的一部分实施与重症监护病房中耐药革兰氏阴性医疗保健获得性感染的减少有关。这些结果进一步支持广泛实施此类举措。
