Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Infect Control Hosp Epidemiol. 2011 Dec;32(12):1158-65. doi: 10.1086/662620. Epub 2011 Oct 17.
To devise a local strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).
Quasi-experimental, before-and-after, interrupted time-series study.
A 1,000-bed tertiary-care university teaching hospital.
Retrospectively, all relevant data were collected from the medical records of patients with CRKP infections from May 2006 through April 2007, the preintervention period. From May 1, 2007, through May 1, 2010, the postintervention period, the intervention was applied and prospectively followed. The 5 key elements of this strategy were an emergency department flagging system, the building of a cohort ward, the eradication of clusters, environmental and personnel hand cultures, and a carbapenem-restriction policy. The demographic and clinical parameters of patients colonized by and/or infected with CRKP were collected from medical records.
A total of 10,680 rectal cultures were performed for 8,376 patients; 433 (5.16%) and 370 (4.4%) were CRKP-colonized and CRKP-infected patients, respectively, and 789 (98%) of 803 patients were admitted to the CRKP cohort ward. The CRKP infection density was reduced from 5.26 to 0.18 per 10,000 patient-days (P ≤ .001), and no nosocomial CRKP infections were diagnosed. Twenty-three percent of environmental cultures were found to be positive. Meropenem use was reduced from 283 ± 70.92 to 118 ± 74.32 defined daily doses per 1,000 patient-days (P ≤ .001).
This intervention produced an enormous impact on patient location, surveillance cultures, and antibiotic policies and a massive investment in infection control resources.
制定一项局部策略，以消除由耐碳青霉烯类肺炎克雷伯菌（CRKP）引起的医院范围内的暴发。
准实验、前后、中断时间序列研究。
一家拥有 1000 张床位的三级教学医院。
回顾性地从 2006 年 5 月至 2007 年 4 月期间患有 CRKP 感染的患者的病历中收集所有相关数据，这是干预前时期。从 2007 年 5 月 1 日至 2010 年 5 月 1 日，应用干预措施并进行前瞻性随访，这是干预后时期。该策略的 5 个关键要素包括急诊部标记系统、建立队列病房、消除集群、环境和人员手培养以及碳青霉烯类限制政策。从病历中收集了定植和/或感染 CRKP 的患者的人口统计学和临床参数。
对 8376 名患者进行了 10680 次直肠培养，其中 433（5.16%）和 370（4.4%）为 CRKP 定植和 CRKP 感染患者，803 名患者中的 789 名（98%）被收入 CRKP 队列病房。CRKP 感染密度从 5.26 降至 0.18/10000 患者日（P ≤.001），且未诊断出医院内 CRKP 感染。23%的环境培养呈阳性。美罗培南使用量从 283 ± 70.92 定义日剂量/1000 患者日降至 118 ± 74.32 定义日剂量/1000 患者日（P ≤.001）。
该干预措施对患者位置、监测培养物和抗生素政策以及对感染控制资源的大量投资产生了巨大影响。
