“筛查与隔离”策略对多重耐药菌的差异：法国成人 ICU 的全国性调查。
Disparity of the "screen-and-isolate" policy for multidrug-resistant organisms: A national survey in French adult ICUs.
机构信息
AP-HP, Hôpital Tenon, Service de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, Paris 75020 cedex 20, France.
AP-HP, Hôpital Tenon, Service de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, 4 rue de la Chine, Paris 75020 cedex 20, France; Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Université Paris 6, Paris, France.
出版信息
Am J Infect Control. 2018 Dec;46(12):1322-1328. doi: 10.1016/j.ajic.2018.05.025. Epub 2018 Jul 3.
BACKGROUND
The prevalence of multidrug-resistant organisms (MDROs) has dramatically increased. The aim of this survey was to describe and analyze the different screening and isolation policies regarding MDROs in French adult intensive care units (ICUs).
MATERIALS AND METHODS
A multicenter online survey was performed among French ICUs, including 63 questions distributed into 4 parts: characteristics of the unit, MDRO screening policy, policy regarding contact precautions, and ecology of the unit.
RESULTS
From April 2015 to June 2016, 73 of 301 ICUs (24%) participated in the survey. MDRO screening was performed on admission in 96% of ICUs, for at least 1 MDRO (78%). MDRO screening was performed weekly during ICU stay in 83% of ICUs. Preemptive isolation was initiated on admission in 82% of ICUs, mostly in a targeted way (71%). Imported and acquired MDRO rates >10% were reported in 44% and 27% of ICUs, respectively. An MDRO outbreak had occurred within the past 3 years in 48% of cases.
CONCLUSION
French ICUs have variable screening and isolation approaches for MDROs, as up to 10 combinations were met. Discrepancies with the 2009 national guidelines were observed. Very few ICUs practice without some form of screening and isolation of patients upon admission.
背景
多药耐药菌（MDRO）的流行率显著增加。本调查的目的是描述和分析法国成人重症监护病房（ICU）中针对 MDRO 的不同筛查和隔离政策。
材料和方法
对法国 ICU 进行了一项多中心在线调查，共包含 63 个问题，分为 4 个部分：单位特征、MDRO 筛查政策、接触预防措施政策以及单位生态。
结果
2015 年 4 月至 2016 年 6 月，301 个 ICU 中有 73 个（24%）参与了调查。96%的 ICU 对入院患者进行 MDRO 筛查，至少筛查 1 种 MDRO（78%）。83%的 ICU 每周对 ICU 住院患者进行 MDRO 筛查。82%的 ICU 在入院时即开始进行预防性隔离，主要是有针对性的隔离（71%）。44%和 27%的 ICU 分别报告了进口和获得性 MDRO 发生率>10%。48%的 ICU 在过去 3 年内发生过 MDRO 暴发。
结论
法国 ICU 对 MDRO 有不同的筛查和隔离方法，最多可同时使用 10 种组合。与 2009 年国家指南存在差异。很少有 ICU 在不进行某种形式的入院患者筛查和隔离的情况下开展工作。
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