1Department of Infection Control and Prevention, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan.
2Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.
Antimicrob Resist Infect Control. 2019 Jun 27;8:110. doi: 10.1186/s13756-019-0564-9. eCollection 2019.
Active surveillance has the potential to prevent nosocomial transmission of carbapenem-resistant (CRAB). We assessed whether rapid diagnosis using clinical specimen-direct loop-mediated isothermal amplification (LAMP), a rapid molecular diagnostic assay, and subsequent intervention, could reduce CRAB nosocomial transmission in intensive care units (ICUs).
A before and after (quasi-experimental) study was conducted in two ICUs at the Mahidol University Faculty of Medicine Ramathibodi Hospital with 3 months of observational period followed by 9 months of interventional period. All patients were screened for CRAB using both the culture and LAMP method from rectal swab and/or bronchial aspirates (intubated patients only) upon admission, weekly thereafter, and upon discharge. During the pre-intervention period, we performed contact precautions based on culture results. In contrast, during the intervention period, we initiated contact precautions within a few hours after sample collection on the basis of LAMP results.
A total of 1335 patients were admitted to the ICUs, of which 866 patients (pre-intervention period: 187; intervention period: 679) were eligible for this study. Incidence rate of CRAB infection decreased to 20.9 per 1000 patient-days in the intervention period from 35.2 in the pre-intervention period ( < 0.02). The calculated hazard ratio of CRAB transmission was 0.65 (95% confidence interval [CI], 0.44-0.97). Risk factors for CRAB acquisition included exposure to carbapenem (hazard ratio, 2.54 [95% CI: 1.61-5.57]).
LAMP screening for CRAB upon ICU admission proved feasible for routine clinical practice. Rapid screening using LAMP followed by early intervention may reduce CRAB transmission rates in ICUs when compared to conventional intervention.
主动监测有可能防止耐碳青霉烯肠杆菌科细菌（CRAB）的医院内传播。我们评估了使用临床标本直接环介导等温扩增（LAMP）快速分子诊断检测进行快速诊断，以及随后的干预措施，是否可以减少重症监护病房（ICU）中的 CRAB 医院内传播。
在玛希隆大学医学院 Rama-thibodi 医院的两个 ICU 中进行了一项前后（准实验）研究，观察期为 3 个月，干预期为 9 个月。所有患者在入院时、此后每周以及出院时，通过直肠拭子和/或支气管抽吸物（仅对插管患者）同时使用培养和 LAMP 方法筛查 CRAB。在预干预期间，我们根据培养结果实施接触预防措施。相比之下，在干预期间，我们根据 LAMP 结果在采集样本后的几个小时内就开始实施接触预防措施。
共有 1335 名患者入住 ICU，其中 866 名患者（预干预期：187 例；干预期：679 例）符合本研究条件。干预期间 CRAB 感染的发病率从预干预期的每 1000 患者日 35.2 例降至 20.9 例（<0.02）。CRAB 传播的计算风险比为 0.65（95%置信区间[CI]，0.44-0.97）。CRAB 获得的危险因素包括接触碳青霉烯类（风险比，2.54[95%CI：1.61-5.57]）。
在 ICU 入院时使用 LAMP 筛查 CRAB 证明可在常规临床实践中实施。与传统干预相比，使用 LAMP 进行快速筛查并随后进行早期干预可能会降低 ICU 中 CRAB 的传播率。
