入院筛查和队列护理可降低越南儿科 ICU 中的碳青霉烯类耐药肠杆菌科。
Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU's.
机构信息
Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18B 4fl, 171 77, Stockholm, Sweden.
Vietnam National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hà Nội, Vietnam.
出版信息
Antimicrob Resist Infect Control. 2021 Aug 30;10(1):128. doi: 10.1186/s13756-021-00994-9.
OBJECTIVES
To assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU's) at the Vietnamese National Children's Hospital.
METHOD
CRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status.
RESULTS
CRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR - 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD.
CONCLUSION
Admission CRE screening and cohort care in pediatric ICU's significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.
目的
评估在越南国家儿童医院的三个重症监护病房（ICU）中，对耐碳青霉烯肠杆菌科（CRE）进行入院筛查和群体护理，是否能减少 CRE 的获得（住院期间的 CRE 定植）、医院获得性感染（HAI）、住院时间、死亡率和成本。
方法
在入院时使用直肠拭子和 ChromIDCarbas 选择性培养进行 CRE 筛查，如果 CRE 为阴性，则每周筛查一次。根据 CRE 定植情况，将患者分组进行治疗。
结果
基线点患病率筛查时 CRE 定植率为 76.9%（103/134）。在 941 名接受 CRE 筛查的患者中，337 名（35.8%）为 CREpos。符合纳入标准的患者有 694 名。244 名入院时 CRE 阴性且筛查次数大于 2 次的患者，根据入院时间分为 8 个相似大小的组（期）。CRE 获得显著下降（OR-3.2，p<0.005），从第二期（最高）的 90%下降到第八期（最后一期）的 48%。与无 CRE 获得的患者相比，CRE 获得的患者有更高的培养确认 HAI 发生率，n=20（14%）比 n=2（2%），更长的住院时间，3.26 周比 2.37 周，更高的总治疗费用，2852 美元比 2295 美元。
结论
在儿科 ICU 中，对 CRE 进行入院筛查和群体护理，显著降低了 CRE 的获得、HAI 的发生和住院时间。
Zotero 插件