Di Cola Simone, Gazda Jakub, Lapenna Lucia, Ceccarelli Giancarlo, Merli Manuela
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovakia.
JHEP Rep. 2023 May;5(5):100703. doi: 10.1016/j.jhepr.2023.100703. Epub 2023 Feb 19.
BACKGROUND & AIMS: Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis.
The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient's exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard.
We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 . 8.9%, <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26-0.73, = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states.
The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes.
Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections.
细菌感染会影响肝硬化患者的生存。由于多重耐药菌的患病率不断上升，医院获得性细菌感染带来了日益严重的医疗保健问题。本研究旨在调查感染预防与控制计划以及2019冠状病毒病（COVID-19）防控措施对医院获得性感染发病率以及一系列次要结局的影响，这些次要结局包括多重耐药菌的患病率、经验性抗生素治疗失败率以及肝硬化患者脓毒症状态的发生情况。
感染预防与控制计划是一项基于抗菌药物管理以及减少患者暴露于危险因素的综合策略。COVID-19防控措施提出了意大利医院和卫生系统建议所规定的进一步行为和卫生限制。我们进行了一项回顾性和前瞻性相结合的研究，比较了额外措施相对于医院标准的影响。
我们分析了941例患者的数据。感染预防与控制计划与医院获得性感染发病率的降低相关（17.8%对8.9%，<0.01）。实施COVID-19防控措施后未出现进一步降低。即使在控制了混杂变量的影响后，感染预防与控制计划的影响仍然显著（比值比0.44，95%置信区间0.26 - 0.73，= 0.002）。此外，该计划的实施降低了多重耐药菌的患病率，降低了经验性抗生素治疗失败率以及脓毒症状态的发生率。
感染预防与控制计划使医院获得性感染的发病率降低了近50%。此外，该计划还降低了大多数次要结局的发生率。基于本研究结果，我们鼓励其他肝病中心采用感染预防与控制计划。
感染对肝硬化患者来说是一个危及生命的问题。此外，由于多重耐药菌的高患病率，医院获得性感染更令人担忧。本研究分析了三个不同时期大量住院肝硬化患者的队列。与第一时期不同，第二时期实施了感染预防计划，减少了医院获得性感染的数量并控制了多重耐药菌。在第三时期，我们实施了更严格的措施以尽量减少COVID-19疫情的影响。然而，这些措施并未导致医院获得性感染的进一步降低。
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