Unit of Anesthesia and Intensive Care, Pescara General Hospital, Pescara, Italy.
Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy.
Int J Infect Dis. 2019 Jul;84:153-162. doi: 10.1016/j.ijid.2019.04.002.
Gram-negative Multi-Drug-Resistant Organisms (GNMDROs) cause an increasing burden of disease in Intensive Care Units (ICUs). We deployed a multifaceted intervention to control selection and transmission of GNMDROs and to estimate at which rate GNMDROs would decline with our interventional bundle.
Interventions implemented in 2015: in-ward Antimicrobial-Stewardship-Program for appropriate management of antimicrobial prescription; infection monitoring with nasal/rectal swabs and repeated procalcitonin assays; 24 h microbiological support (since 2016); prevention of catheter-related infections, VAPs and in-ward GNMDROs transmission; education of ICU personnel. In May 2017, epidemiological, clinical and microbiological data were collected and retrospectively analyzed. Rates of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, as well as percentages of resistance among all Gram-negative bacteria were compared during the study period.
Of 668 patients, at least one isolate was obtained from 399 patients. The proportions of patients with infection and with Gram-negative isolates were even across the 5 semesters (p = 0.8). For Klebsiella pneumoniae, the number of strains resistant to carbapenems fell from 94% to 6% (p < 0.001). Significant drops were also observed for Pseudomonas aeruginosa and Acinetobacter baumannii. Percentages of resistance for all Gram-negative isolates fell from 91% to 13% (p < 0.0001). The reduction in antibiotic prescription translated in a considerable reduction of pharmacy costs. Multivariate models confirmed that the hospitalization semester was the most relevant independent predictor of resistance among Gram-negative bacteria.
Our experience provides further evidence that a multi-faceted intervention, aimed to reduce selection and transmission of GNMDROs with efficient microbiological support, may yield remarkable results in a short time interval.
革兰氏阴性多药耐药菌（GNMDRO）在重症监护病房（ICU）造成的疾病负担日益加重。我们采取了多方面的干预措施来控制 GNMDRO 的选择和传播，并估计我们的干预措施会在多大程度上降低 GNMDRO 的水平。
2015 年实施的干预措施：病房内抗菌药物管理计划，以合理管理抗菌药物处方；鼻/直肠拭子和重复降钙素原检测进行感染监测；24 小时微生物学支持（自 2016 年起）；预防导管相关感染、呼吸机相关性肺炎和病房内 GNMDRO 传播；对 ICU 人员进行教育。2017 年 5 月，收集了流行病学、临床和微生物学数据，并进行了回顾性分析。在研究期间，比较了肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的耐药率，以及所有革兰氏阴性菌的耐药率百分比。
在 668 名患者中，有 399 名患者至少分离出一种菌株。在 5 个学期中，感染患者和革兰氏阴性菌分离患者的比例基本相同（p=0.8）。对于肺炎克雷伯菌，对碳青霉烯类药物耐药的菌株数量从 94%降至 6%（p<0.001）。铜绿假单胞菌和鲍曼不动杆菌也观察到显著下降。所有革兰氏阴性菌的耐药率从 91%降至 13%（p<0.0001）。抗生素处方的减少导致了药房成本的显著降低。多变量模型证实，住院学期是革兰氏阴性菌耐药的最相关独立预测因素。
我们的经验进一步证明，多方面的干预措施，旨在通过有效的微生物学支持减少 GNMDRO 的选择和传播，可能在短时间内产生显著的效果。
