中心静脉导管相关性血流感染、多重耐药菌血症和感染控制干预：希腊一家三级保健医院的 6 年时间序列分析。

Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece.

机构信息

Clinical Pharmacology Department, Athens Medical Centre, Marousi, Athens, Greece.

Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.

出版信息

J Hosp Infect. 2022 May;123:27-33. doi: 10.1016/j.jhin.2022.01.020. Epub 2022 Feb 9.

DOI:10.1016/j.jhin.2022.01.020

PMID:35149172

Abstract

BACKGROUND

Central-line-associated bloodstream infections (CLABSIs) are serious healthcare-associated infections with substantial morbidity and hospital costs.

AIM

To investigate the association between the incidence of CLABSIs, the implementation of specific infection control measures, and the incidence of multi-drug-resistant (MDR) bacteraemias in a tertiary care hospital in Greece from 2013 to 2018.

METHODS

Analysis was applied for the following indices, calculated monthly: CLABSI rate; use of hand hygiene disinfectants; isolation rate of patients with MDR bacteria; and incidence of bacteraemias [total Gram-negative carbapenem-resistant Acinetobacter baumanii, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae; and Gram-positive meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci].

FINDINGS

The total number of bacteraemias from carbapenem-resistant Gram-negative pathogens was significantly correlated with an increased CLABSI rate for all (total) hospital departments [incidence rate ratio (IRR) 1.17, 95% confidence interval (CI) 1.05-1.31, P=0.006] and the adult intensive care unit (ICU) (IRR 1.37, 95% CI 1.07-1.75, P=0.013). In the adult ICU, every increase in the incidence of each resistant Gram-negative pathogen was significantly correlated with a decreased CLABSI rate (carbapenem-resistant A. baumanii: IRR 0.59, 95% CI 0.39-0.90, P=0.015; carbapenem-resistant K. pneumoniae: IRR 0.48, 95% CI 0.25-0.94, P=0.031; carbapenem-resistant P. aeruginosa: IRR 0.54, 95% CI 0.33-0.89, P=0.015). The use of hand disinfectants was correlated with a decreased CLABSI rate 1-3 months before the application of this intervention for all (total) hospital departments (IRR 0.80, 95% CI 0.69-0.93, P=0.005), and for scrub disinfectants in the current month for the adult ICU (IRR 0.34, 95% CI 0.11-1.03, P=0.057). Isolation of patients with MDR pathogens was not associated with the incidence of CLABSIs.

CONCLUSION

Hand hygiene was associated with a significant reduction in the incidence of CLABSIs at the study hospital. Time-series analysis is an important tool to evaluate infection control interventions.

摘要

背景

中心静脉相关血流感染（CLABSI）是一种严重的医疗相关感染，具有较高的发病率和住院费用。

目的

研究 2013 年至 2018 年期间希腊一家三级保健医院 CLABSI 发生率、特定感染控制措施的实施与多药耐药（MDR）菌血症发生率之间的关系。

方法

对以下每月计算的指标进行分析：CLABSI 发生率；手部卫生消毒剂的使用；MDR 细菌感染患者的隔离率；以及血培养阳性率[总革兰阴性碳青霉烯耐药鲍曼不动杆菌、碳青霉烯耐药铜绿假单胞菌和碳青霉烯耐药肺炎克雷伯菌；革兰阳性耐甲氧西林金黄色葡萄球菌和万古霉素耐药肠球菌]。

结果

耐碳青霉烯类革兰阴性病原体引起的总菌血症数量与所有（总）医院科室的 CLABSI 发生率呈显著正相关（发病率比 1.17，95%置信区间 1.05-1.31，P=0.006）和成人重症监护病房（ICU）（发病率比 1.37，95%置信区间 1.07-1.75，P=0.013）。在成人 ICU 中，每种耐药革兰阴性病原体的发病率增加与 CLABSI 发生率降低呈显著相关（耐碳青霉烯类鲍曼不动杆菌：发病率比 0.59，95%置信区间 0.39-0.90，P=0.015；耐碳青霉烯类肺炎克雷伯菌：发病率比 0.48，95%置信区间 0.25-0.94，P=0.031；耐碳青霉烯类铜绿假单胞菌：发病率比 0.54，95%置信区间 0.33-0.89，P=0.015）。手部消毒剂的使用与所有（总）医院科室的 CLABSI 发生率在干预前 1-3 个月呈显著负相关（发病率比 0.80，95%置信区间 0.69-0.93，P=0.005），且在当前月份成人 ICU 中用于刷手的消毒剂与 CLABSI 发生率呈显著负相关（发病率比 0.34，95%置信区间 0.11-1.03，P=0.057）。MDR 病原体感染患者的隔离与 CLABSI 发生率无关。