Infection Control Committee, Tzaneio General Hospital, Piraeus, Greece.
Department of Clinical Microbiology, Tzaneio General Hospital, Piraeus, Greece.
Eur J Clin Microbiol Infect Dis. 2018 Jan;37(1):43-50. doi: 10.1007/s10096-017-3098-1. Epub 2017 Sep 6.
We evaluated an infection control (IC) program influenced by personnel and material resource shortages on the incidence of bloodstream infections (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA) in an endemic region. Between January 2010 and December 2015, all BSI episodes caused by CRKP, CRAB, and CRPA were recorded. An IC bundle was implemented in January 2012. We evaluated the effect of the interventions on BSI rates between the pre-intervention (2010-2011) and intervention (2012-2013) periods, using an interrupted time-series model. From 2014, when interventions were still applied, BSI incidence was gradually increased. For this reason, we evaluated with a linear mixed effects model several factors possibly contributing to this increase for the years 2012-2015, which was considered as the intervention/follow-up period. During the study period, 351 patients with BSI were recorded, with a total of 538 episodes; the majority (83.6%) occurred in the intensive care unit (ICU). The BSI incidence rate per year during 2010-2015 for ICU patients was 21.03/19.63/17.32/14.45/22.85/25.02 per 1000 patient-days, respectively, with the reduction in BSI levels after the start of intervention marginal (p = 0.054). During the follow-up period (2014-2015), the most influential factors for the increased BSI incidence were the reduced participation in educational courses and compliance with hand hygiene. The implementation of IC interventions reduced the BSI incidence rates, particularly for ICU patients. However, factors possibly related to the restrictions of human and material resources apparently contributed to the observed expansion of BSI in our endemic setting.
我们评估了在人员和物质资源短缺的情况下，感染控制（IC）计划对流行地区耐碳青霉烯类肺炎克雷伯菌（CRKP）、鲍曼不动杆菌（CRAB）和铜绿假单胞菌（CRPA）引起血流感染（BSI）发生率的影响。在 2010 年 1 月至 2015 年 12 月期间，记录了所有由 CRKP、CRAB 和 CRPA 引起的 BSI 病例。2012 年 1 月实施了感染控制措施。我们使用中断时间序列模型评估了干预措施对干预前（2010-2011 年）和干预期间（2012-2013 年）BSI 发生率的影响。2014 年，当干预措施仍在实施时，BSI 的发病率逐渐增加。因此，我们使用线性混合效应模型评估了 2012-2015 年可能导致发病率增加的几个因素，这一年被认为是干预/随访期。在研究期间，记录了 351 例 BSI 患者，共 538 例；大多数（83.6%）发生在重症监护病房（ICU）。2010-2015 年 ICU 患者每年 BSI 发生率分别为 21.03/19.63/17.32/14.45/22.85/25.02/1000 患者日，干预开始后 BSI 水平略有下降（p=0.054）。在随访期间（2014-2015 年），导致 BSI 发病率增加的最主要因素是参加教育课程和遵守手卫生的人数减少。感染控制干预措施的实施降低了 BSI 发生率，尤其是 ICU 患者。然而，与人员和物质资源限制有关的因素显然导致了我们流行地区 BSI 的扩张。
