Direction de la Politique Medicale-Directorate of Medical Politics, Assistance Publique-Hopitaux de Paris, Paris, France.
Euro Surveill. 2012 Jul 26;17(30):20229.
Repeated outbreaks of vancomycin-resistant Enterococcus faecium (VRE) occurred between 2004 and 2010 in Assistance Publique--Hôpitaux de Paris (AP-HP), a 23,000-bed multi-hospital institution. From August 2004 to December 2005, the French guidelines for preventing cross-transmission of multiresistant bacteria were applied. Because the number of VRE cases continued to increase, an institutional control programme was implemented from January 2006 onwards: it foresees stopping transfer of VRE and contact patients, separating VRE and contact patients in distinct cohorts, intervention of a central infection control team to support local teams, and quick application of measures as soon as first VRE cases are identified. Between August 2004 and December 2010, 45 VRE outbreaks occurred in 21 of the 38 AP-HP hospitals, comprising 533 cases. Time series analysis showed that the mean number of cases increased by 0.8 cases per month (95% confidence interval (CI): 0.3 to 1.3, p=0.001) before, and decreased by 0.7 cases per month after implementation of the programme (95% CI: -0.9 to -0.5, p<0.001), resulting in a significant trend change of -1.5 cases per month (95% CI: -2.1 to -0.9, p<0.001). The number of cases per outbreak was significantly lower after implementation of the programme. A sustained and coordinated strategy can control emerging bacteria at the level of a large regional multihospital institution.
2004 年至 2010 年期间，法国巴黎公立医院集团（AP-HP）发生了多次万古霉素耐药肠球菌（VRE）爆发。2004 年 8 月至 2005 年 12 月期间，法国应用了预防多重耐药菌交叉传播的指南。由于 VRE 病例数量持续增加，自 2006 年 1 月起实施了机构控制计划：该计划包括停止 VRE 和接触患者的转移、将 VRE 和接触患者分开在不同的队列中、由中央感染控制团队支持当地团队，以及一旦发现首例 VRE 病例就迅速采取措施。2004 年 8 月至 2010 年 12 月期间，在 38 家 AP-HP 医院中的 21 家医院发生了 45 起 VRE 爆发，共涉及 533 例病例。时间序列分析显示，在实施该计划之前，每月平均病例数增加了 0.8 例（95%置信区间（CI）：0.3 至 1.3，p=0.001），实施该计划后每月减少了 0.7 例（95% CI：-0.9 至 -0.5，p<0.001），导致每月趋势变化显著减少 1.5 例（95% CI：-2.1 至 -0.9，p<0.001）。实施该计划后，每起爆发的病例数明显减少。持续协调的策略可以在大型区域性多医院机构层面控制新出现的细菌。
