建立模型干预和接触网络，以减少 ICU 中个体之间耐碳青霉烯类抗生素的细菌的传播。
Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU.
机构信息
School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA.
出版信息
J Hosp Infect. 2023 Jun;136:1-7. doi: 10.1016/j.jhin.2023.02.016. Epub 2023 Mar 11.
BACKGROUND
Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited.
OBJECTIVE
To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization.
DESIGN, SETTING AND PARTICIPANTS: CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI).
EXPOSURES
The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions.
MAIN OUTCOMES AND MEASURES
The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition).
RESULTS
Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29).
CONCLUSIONS AND RELEVANCE
In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
背景
接触预防措施被广泛用于预防医院病房中耐碳青霉烯类肠杆菌科细菌（CRO）的传播。然而，其在自然医院环境中的有效性证据有限。
目的
确定哪些接触预防措施、医护人员（HCW）与患者的互动以及患者和病房的特征与 CRO 感染或定植的风险增加相关。
设计、设置和参与者：通过概率建模评估来自两个高重症监护病房的 CRO 临床和监测培养物，以描述易感患者在病房停留期间感染或定植 CRO 的风险。使用带有用户和时间戳的电子健康记录来构建患者之间 HCW 介导的接触网络。概率模型调整了患者（例如抗生素的使用）和病房（例如手卫生依从性、环境清洁）的特征。通过调整后的优势比（aOR）和 95%贝叶斯可信区间（CrI）评估风险因素的影响。
暴露
与 CRO 阳性患者的互动程度，按 CRO 阳性患者是否采取接触预防措施进行分层。
主要结果和测量
CRO 的流行率和新携带者的数量（即 CRO 的新感染）。
结果
在 2193 次病房就诊中，有 126 名（5.8%）患者发生了 CRO 定植或感染。易感患者每天与接触预防措施下的 CRO 阳性个体有 4.8 次互动（与未采取接触预防措施的个体有 1.9 次互动）。对 CRO 阳性患者采取接触预防措施与易感患者中 CRO 获得的发生率（每 1000 个患者风险日为 7.4 例 vs 93.5 例）和几率（aOR 0.03，95%CrI 0.01-0.17）降低相关，导致绝对风险降低估计为 9.0%（95%CrI 7.6-9.2%）。此外，易感患者接受碳青霉烯类药物治疗与 CRO 获得的几率增加相关（aOR 2.38，95%CrI 1.70-3.29）。
结论和相关性
在这项基于人群的队列研究中，即使在调整了抗生素暴露的情况下，对 CRO 定植或感染的患者采取接触预防措施，与易感患者中 CRO 获得的风险降低相关。需要进一步包括病原体基因分型的研究来证实这些发现。
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