通过在植入左心室辅助装置前用洗必泰和莫匹罗星对患有晚期心力衰竭的患者进行常规术前普遍去定植以减少术后感染：一项单中心观察性研究。
Reduction of Postoperative Infections Through Routine Preoperative Universal Decolonization of Advanced Heart Failure Patients With Chlorhexidine and Mupirocin Before Left Ventricular Assist Device Implantation: A Single-Center Observational Study.
机构信息
Susan George, DNP, ACNP, CCNS, CCRN, CMC, CHFN, is a heart failure advanced practice nurse, INTEGRIS Baptist Medical Center, Oklahoma City, OK. A. Renee Leasure, PhD, RN, CNS, CCRN, is an associate professor, Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences, Oklahoma City, OK. Angela McGovern, BSN, RN, is intake coordinator for advanced heart failure therapy, INTEGRIS Baptist Medical Center, Oklahoma City, OK. Douglas A. Horstmanshof, MD, FACC, is codirector of INTEGRIS Advanced Cardiac Care Program, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
出版信息
Dimens Crit Care Nurs. 2020 Nov/Dec;39(6):312-320. doi: 10.1097/DCC.0000000000000443.
BACKGROUND
Left ventricular assist devices (LVADs) are increasingly being used in patients with advanced heart failure as bridge to transplant, bridge to decision, or destination therapy. Infections are a major complication associated with LVADs. Staphylococcus aureus is one of the common causative organisms associated with LVAD infections. Methicillin resistant staphylococcus aureus (MRSA)-colonized patients are at an increased risk for developing MRSA-associated infections. Various studies have demonstrated decolonization of skin with topical chlorhexidine and nares with 2% intranasal mupirocin ointment is effective in reducing MRSA-associated infections.
OBJECTIVE
The objective of this observational study was to examine the impact of a universal decolonization protocol using topical chlorhexidine and intranasal mupirocin ointment for 5 days before LVAD implantation on postoperative infections (30, 60, and 90 days) and 30-day infection-related rehospitalization.
METHODS
A preoperative universal decolonization with 4% chlorhexidine daily whole-body bath and 2% intranasal mupirocin ointment twice a day for 5 days was implemented for patients undergoing elective LVAD implantation. Using an observational study design, we included a convenience sample of 84 subjects who were established patients in an accredited advanced heart failure program. Thirty-seven patients served in the standard protocol group, and 47 in the universal decolonization protocol group participated in the observational study.
RESULTS
In the standard protocol group, there were 4 MRSA infections with none in the universal decolonization group (χ = 5.34, P = .03). In total, there were 8 surgical site infections in the standard protocol group and 1 in the universal decolonization group (χ = 5.95, P = .01).
CONCLUSION
A 5-day universal decolonization protocol before LVAD implantation was effective in reducing total infections as well as MRSA-specific infections.
背景
左心室辅助装置（LVAD）越来越多地被用于晚期心力衰竭患者，作为心脏移植的桥接、决策的桥接或终末期治疗。感染是与 LVAD 相关的主要并发症。金黄色葡萄球菌是与 LVAD 感染相关的常见病原体之一。耐甲氧西林金黄色葡萄球菌（MRSA）定植患者发生 MRSA 相关感染的风险增加。多项研究表明，用外用氯己定对皮肤进行去定植和用 2%的鼻腔内莫匹罗星软膏对鼻腔进行去定植，可有效降低 MRSA 相关感染。
目的
本观察性研究的目的是检验在 LVAD 植入术前 5 天使用外用氯己定和鼻腔内莫匹罗星软膏进行全身去定植方案对术后（30、60 和 90 天）感染和 30 天感染相关再入院的影响。
方法
对择期接受 LVAD 植入的患者，术前用 4%的氯己定进行全身沐浴，每天一次，并用 2%的鼻腔内莫匹罗星软膏每天两次，共 5 天，进行术前全身去定植。采用观察性研究设计，我们纳入了一个经认证的先进心力衰竭项目中的 84 名方便样本患者。37 名患者纳入标准方案组，47 名患者纳入全身去定植方案组参与观察性研究。
结果
在标准方案组中，有 4 例 MRSA 感染，而在全身去定植组中没有（χ = 5.34，P =.03）。标准方案组共有 8 例手术部位感染，而全身去定植组有 1 例（χ = 5.95，P =.01）。
结论
在 LVAD 植入术前进行 5 天的全身去定植方案可有效降低总感染率和 MRSA 特异性感染率。
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