Kim Hyung-Jun, Jeong EuiSeok, Choe Pyoeng Gyun, Lee Sang-Min, Lee Jinwoo
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Infection Control Center, Seoul National University Hospital, Seoul, Korea.
Acute Crit Care. 2018 Nov;33(4):238-245. doi: 10.4266/acc.2018.00220. Epub 2018 Nov 14.
Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes.
Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured.
A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days).
Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.
多重耐药（MDR）病原体感染会导致重症监护病房（ICU）患者预后不良。接触预防措施对于减少MDR病原体的传播至关重要。然而，周围环境的重要性尚不为人所知。我们研究了ICU搬迁对MDR呼吸道病原体检测率和患者预后的影响。
对搬迁前后入住ICU的患者进行回顾性分析。测量患者的基线特征、检测到的呼吸道病原体类型、使用的抗生素以及患者预后。
共纳入了463例在搬迁前后4个月入住ICU的成年患者。其中，234例在搬迁前入住ICU，229例在搬迁后入住。两组患者的基线特征，包括年龄、性别和基础合并症，没有差异。搬迁后，MDR呼吸道病原体检测的发病率从每1000患者日90.0例降至68.8例，但差异无统计学意义。黏菌素的使用天数从53.5天（95%置信区间[CI]，20.3至86.7天）显著减少至18.7天（95%CI，5.6至31.7天）。此外，住院时间中位数从29天（四分位间距[IQR]，14至50天）显著缩短至21天（IQR，11至39天）。
ICU搬迁前后MDR呼吸道病原体检测的发病率没有显著差异。然而，ICU搬迁有助于减少针对MDR病原体的抗生素使用并改善患者预后。
