Department of Vital Functions, University Medical Center Utrecht, Utrecht, The Netherlands.
Crit Care Med. 2011 Jun;39(6):1313-21. doi: 10.1097/CCM.0b013e3182120815.
Cross-transmission of Gram-negative bacteria increases the likelihood of acquisition of infections and emergence of antibiotic resistance in intensive care units. Respiratory tracts of mechanically ventilated patients are frequently colonized with Gram-negative bacteria and endotracheal suctioning may facilitate cross-transmission. It is unknown whether closed suction systems, as compared with open suction systems, prevent cross-transmission. The objective was to determine whether closed suction systems, as compared with open suction systems, reduce the incidence of cross-transmission of Gram-negative bacteria in intensive care units.
We performed a prospective crossover study in which both systems were tested unitwide in four intensive care units.
Two intensive care units from a university hospital and two from a teaching hospital participated in the trial between January 2007 and February 2008.
All patients admitted to the intensive care unit for >24 hrs were included.
Closed suction systems and open suction systems were used for all patients requiring mechanical ventilation during 6-month clusters with the order of systems randomized per intensive care unit.
Acquisition and cross-transmission rates of selected Gram-negative bacteria were determined through extensive microbiological surveillance and genotyping. Among 1,110 patients (585 with closed suction systems and 525 with open suction systems), acquisition for selected Gram-negative bacteria was 35.5 and 32.5 per 1,000 patient-days at risk during closed suction period and open suction period, respectively (adjusted hazard ratio, 1.14; 95% confidence interval, 0.9-1.4). During closed suction period, adjusted hazard ratios for acquisition were 0.66 (95% confidence interval, 0.45-0.97) for Pseudomonas aeruginosa and 2.03 (95% confidence interval, 1.15-3.57) for Acinetobacter species; acquisition rates of other pathogens did not differ significantly. Adjusted hazard ratios for cross-transmission during closed suction period 0.9 (0.4-1.9) for P. aeruginosa, 6.7 (1.5-30.1) for Acinetobacter, and 0.3 (0.03-2.7) for Enterobacter species. Overall cross-transmission rates were 5.9 (closed suction systems) and 4.7 (open suction systems) per 1,000 patient-days at risk.
Closed suction systems failed to reduce cross-transmission and acquisition rates of the most relevant Gram-negative bacteria in intensive care unit patients.
革兰氏阴性菌的交叉传播增加了重症监护病房获得感染和出现抗生素耐药性的可能性。机械通气患者的呼吸道经常定植有革兰氏阴性菌，而气管内吸引可能促进交叉传播。目前尚不清楚与开放式吸引系统相比，密闭式吸引系统是否可以预防交叉传播。本研究旨在确定与开放式吸引系统相比，密闭式吸引系统是否可以降低重症监护病房革兰氏阴性菌的交叉传播发生率。
我们进行了一项前瞻性交叉研究，在四个重症监护病房中对两种系统进行了全面测试。
2007 年 1 月至 2008 年 2 月期间，一家大学医院和一家教学医院的两个重症监护病房参加了这项试验。
所有入住重症监护病房超过 24 小时的患者均纳入研究。
在 6 个月的时间内，对所有需要机械通气的患者使用密闭式和开放式吸引系统，每个重症监护病房按系统顺序进行随机分组。
通过广泛的微生物监测和基因分型确定所选革兰氏阴性菌的获得和交叉传播率。在 1110 例患者中（585 例使用密闭式吸引系统，525 例使用开放式吸引系统），在密闭式吸引期和开放式吸引期，选定的革兰氏阴性菌的获得率分别为每 1000 个患者日 35.5 和 32.5 例（校正危险比，1.14；95%置信区间，0.9-1.4）。在密闭式吸引期，铜绿假单胞菌和不动杆菌的校正获得危险比分别为 0.66（95%置信区间，0.45-0.97）和 2.03（95%置信区间，1.15-3.57）；其他病原体的获得率无显著差异。在密闭式吸引期，铜绿假单胞菌和不动杆菌的交叉传播校正危险比分别为 0.9（0.4-1.9）和 6.7（1.5-30.1），肠杆菌属的交叉传播校正危险比为 0.3（0.03-2.7）。总体交叉传播率分别为每 1000 个患者日 5.9（密闭式吸引系统）和 4.7（开放式吸引系统）。
与开放式吸引系统相比，密闭式吸引系统未能降低重症监护病房患者中最相关的革兰氏阴性菌的交叉传播和获得率。
