Medioli Filippo, Bacca Erica, Faltoni Matteo, Burastero Giulia Jole, Volpi Sara, Menozzi Marianna, Orlando Gabriella, Bedini Andrea, Franceschini Erica, Mussini Cristina, Meschiari Marianna
Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
Clinic of Infectious Diseases, Department of Infectious Diseases, University of Modena, 41124 Modena, Italy.
Antibiotics (Basel). 2022 Jul 28;11(8):1015. doi: 10.3390/antibiotics11081015.
Despite the global efforts to antagonize carbapenem-resistant (CRAB) spreading, it remains an emerging threat with a related mortality exceeding 40% among critically ill patients. The purpose of this review is to provide evidence concerning the best infection prevention and control (IPC) strategies to fight CRAB spreading in endemic hospitals.
The study was a critical review of the literature aiming to evaluate all available studies reporting IPC measures to control CRAB in ICU and outside ICU in both epidemic and endemic settings in the past 10 years.
Among the 12 included studies, the majority consisted of research reports of outbreaks mostly occurred in ICUs. The reported mortality reached 50%. Wide variability was observed related to the frequency of application of recommended CRAB IPC measures among the studies: environmental disinfection (100%); contact precautions (83%); cohorting staff and patients (75%); genotyping (66%); daily chlorhexidine baths (58%); active rectal screening (50%); closing or stopping admissions to the ward (33%).
Despite effective control of CRAB spreading during the outbreaks, the IPC measures reported were heterogeneous and highly dependent on the different setting as well as on the structural characteristics of the wards. Reinforced 'search and destroy' strategies both on the environment and on the patient, proved to be the most effective measures for permanently eliminating CRAB spreading.
尽管全球都在努力对抗耐碳青霉烯类鲍曼不动杆菌（CRAB）的传播，但它仍是一种新出现的威胁，在重症患者中的相关死亡率超过40%。本综述的目的是提供有关最佳感染预防与控制（IPC）策略的证据，以对抗CRAB在地方流行医院的传播。
该研究是对文献的批判性综述，旨在评估过去10年中所有报告在流行和地方流行环境下，在重症监护病房（ICU）内外控制CRAB的IPC措施的现有研究。
在纳入的12项研究中，大多数是关于主要发生在ICU的暴发的研究报告。报告的死亡率达到50%。在各项研究中，推荐的CRAB IPC措施的应用频率存在很大差异：环境消毒（100%）；接触预防措施（83%）；医护人员和患者分组（75%）；基因分型（66%）；每日洗必泰浴（58%）；直肠主动筛查（50%）；关闭或停止病房收治（33%）。
尽管在暴发期间有效地控制了CRAB的传播，但报告的IPC措施存在异质性，并且高度依赖于不同的环境以及病房的结构特征。事实证明，加强针对环境和患者的“搜索并消灭”策略是永久消除CRAB传播的最有效措施。
