Dananché Cédric, Bénet Thomas, Allaouchiche Bernard, Hernu Romain, Argaud Laurent, Dauwalder Olivier, Vandenesch François, Vanhems Philippe
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
Epidemiology and Public Health Group, University of Lyon 1, 8, avenue Rockefeller, 69373, Lyon, Cedex 08, France.
Crit Care. 2015 Feb 10;19(1):38. doi: 10.1186/s13054-015-0754-7.
Identification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; however, little is known about its effectiveness. The aim of this study was to evaluate the impact of 'targeted screening' at patient admission to intensive care units (ICUs) on the incidence of 3GC-RE hospital-acquired infections (HAIs) and compare it to 'universal screening'.
We undertook a quasi-experimental study of two ICUs (unit A: intervention group; unit B: control group) at a university-affiliated hospital between 1 January 2008 and 31 December 2011. In unit A, patients were screened universally for 3GC-RE at admission during period 1 (1 January 2008 through 30 September 2010). During period 2 (2011 calendar year), the intervention was implemented in unit A; patients transferred from another unit or hospital were screened selectively. In unit B, all patients were screened throughout periods 1 and 2. 3GC-RE-related HAI incidence rates were expressed per 1,000 patient-days. Incidence rate ratios (IRRs) were examined by multivariate Poisson regression modelling.
In unit A, 3GC-RE-related HAI incidence rates decreased from 5.4 (95% confidence interval (CI), 4.1 to 7.0) during period 1 to 1.3 (95% CI, 0.5 to 2.9) during period 2 (P < 0.001). No changes were observed in unit B between periods 1 and 2 (P = 0.5). In unit A, the adjusted incidence of 3GC-RE-related HAIs decreased in period 2 compared with period 1 (adjusted IRR, 0.3; 95% CI, 0.1 to 0.9; P = 0.03) independently of temporal trend, trauma and age. No changes were seen in unit B (P = 0.4). The total number of rectal swabs taken showed an 85% decrease in unit A between period 1 and 2 (P < 0.001).
Targeted screening of 3GC-RE carriers at ICU admission was not associated with an increase in 3GC-RE-related HAI incidence compared with universal screening. Total number of rectal swabs decreased significantly. These findings suggest that targeted screening may be worth assessing as an alternative to universal screening.
入院时通过直肠筛查识别第三代头孢菌素耐药肠杆菌科细菌（3GC - RE）携带者似乎是预防传播和暴发的重要一步；然而，其有效性鲜为人知。本研究的目的是评估重症监护病房（ICU）患者入院时“目标性筛查”对3GC - RE医院获得性感染（HAI）发生率的影响，并将其与“全面筛查”进行比较。
2008年1月1日至2011年12月31日期间，我们在一家大学附属医院对两个ICU（A单元：干预组；B单元：对照组）进行了一项准实验研究。在A单元，第1阶段（2008年1月1日至2010年9月30日）对患者入院时进行3GC - RE全面筛查。在第2阶段（2011日历年），在A单元实施干预；对从其他单元或医院转入的患者进行选择性筛查。在B单元，在第1阶段和第2阶段对所有患者进行筛查。3GC - RE相关HAI发病率以每1000患者日表示。通过多变量泊松回归模型检查发病率比（IRR）。
在A单元，3GC - RE相关HAI发病率从第1阶段的5.4（95%置信区间（CI），4.1至7.0）降至第2阶段的1.3（95%CI，0.5至2.9）（P < 0.001）。在B单元，第1阶段和第2阶段之间未观察到变化（P = 0.5）。在A单元，与第1阶段相比，第2阶段3GC - RE相关HAI的校正发病率下降（校正IRR，0.3；95%CI，0.1至0.9；P = 0.03），与时间趋势、创伤和年龄无关。在B单元未观察到变化（P = 0.4）。第1阶段和第2阶段之间，A单元采集的直肠拭子总数减少了85%（P < 0.001）。
与全面筛查相比，ICU入院时对3GC - RE携带者进行目标性筛查与3GC - RE相关HAI发病率增加无关。直肠拭子总数显著减少。这些发现表明，目标性筛查作为全面筛查的替代方法可能值得评估。
