Faculdade de Medicina da Universidade de São Paulo, Department of Infectious Diseases and LIM 54, São Paulo/SPSP, Brazil.
Clinics (Sao Paulo). 2013;68(8):1128-33. doi: 10.6061/clinics/2013(08)11.
To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp.
Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge. The outcome was colonization by these pathogens. Two interventions were implemented: education and the introduction of alcohol rubs. Compliance with hand hygiene, colonization pressure, colonization at admission and risk factors for colonization were evaluated.
The probability of becoming colonized increased during the study. The incidence density of colonization by carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. and colonization pressure were different between periods, increasing gradually throughout the study. The increase in colonization pressure was due to patients already colonized at admission. The APACHE II score, colonization pressure in the week before the outcome and male gender were independent risk factors for colonization. Every 1% increase in colonization pressure led to a 2% increase in the risk of being colonized.
Colonization pressure is a risk factor for carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. colonization. When this pressure reaches critical levels, efforts primarily aimed at hand hygiene may not be sufficient to prevent transmission.
确定与耐碳青霉烯铜绿假单胞菌和多药耐药不动杆菌定植相关的因素。
对入住重症监护病房的患者在入院时、入院后第 3 天和每周进行监测培养，直至出院。研究的结局是这些病原体的定植情况。实施了两项干预措施：教育和酒精擦拭。评估了手卫生依从性、定植压力、入院时定植情况和定植的危险因素。
研究期间，定植的可能性增加。耐碳青霉烯铜绿假单胞菌和多药耐药不动杆菌定植的发病率密度和定植压力在各时间段不同，整个研究期间逐渐增加。定植压力的增加是由于患者在入院时已经定植。APACHE II 评分、结局前一周的定植压力和男性是定植的独立危险因素。定植压力每增加 1%，定植的风险就增加 2%。
定植压力是耐碳青霉烯铜绿假单胞菌和多药耐药不动杆菌定植的危险因素。当这种压力达到临界水平时，主要针对手卫生的措施可能不足以防止传播。
