Gopaul Steven, Dominic Catherine, Tinhuna Juliana, Green James, Watkins Eleanor, Melzer Mark
James Paget University Hospital NHS Foundation Trust, Great Yarmouth, United Kingdom.
Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Infect Prev Pract. 2023 Mar 23;5(2):100280. doi: 10.1016/j.infpip.2023.100280. eCollection 2023 Jun.
Until recently, healthcare-associated bacteraemia was a neglected area of infection prevention and control (IPC), despite a 30-day mortality of 15-20%. Recently, the UK Department of Health (DH) introduced a target to reduce hospital-acquired bacteraemias by 50% over a five-year period. Following implementation of multifaceted and multidisciplinary interventions, the aim of this study was to determine its impact on achieving this target.
From April 2017 to March 2022, consecutive hospital-acquired bacteraemic inpatients within Barts Health NHS Trust were prospectively studied. Using quality improvement methodology, and implementing the plan, do, study, act (PDSA) cycle at each stage, antibiotic prophylaxis for high-risk procedures were modified and 'good practice' interventions around medical devices introduced. Characteristics of bacteraemic patients were analysed and trends in bacteraemic episodes recorded. Statistical analysis was undertaken in Stata SE (version 16).
There were 770 patients and 797 episodes of hospital-acquired bacteraemias. Following a baseline of 134 episodes in 2017-18, this peaked at 194 in 2019-20 before dropping to 157 in 2020-21 and 159 in 2021-22. Most hospital-acquired bacteraemias occurred in those aged > 50, 551 (69.1%), with the highest proportion occurring in those age > 70, 292 (36.6%). Hospital-acquired bacteraemia occurred more commonly between October to December.Most episodes occurred in either medicine or care of the elderly patients, 345 (43.3%), specialist surgery, 141 (17.7%), haematology/oncology, 127 (15.9%) and patients requiring critical care, 108 (13.6%). The urinary tract, 336 (42.2%), both catheter and non-catheter associated, was the commonest sites of infection. 175 (22.0%) of bacteraemic isolates were extended spectrum beta lactamase (ESB) producing. Co-amoxiclav resistance was 315 (39.5%), ciprofloxacin resistance 246 (30.9%) and gentamicin resistance 123 (15.4%). At 7 days, 77 patients (9.7%; 95% CI 7.4-12.2%) died and by 30 days this had risen to 129 (16.2%; 95% CI 13.7-19.9%).
Despite implementation of quality improvement (QI) interventions, it was not possible to achieve a 50% reduction from baseline although an 18% reduction was achieved from 2019-20 onwards. Our work highlights the importance of antimicrobial prophylaxis and medical device 'good practice'. Over time, these interventions, if properly implemented, could further reduce healthcare-associated bacteraemic infection.
直到最近，医疗保健相关菌血症一直是感染预防与控制（IPC）中一个被忽视的领域，尽管其30天死亡率为15%-20%。最近，英国卫生部（DH）提出了一个目标，即在五年内将医院获得性菌血症减少50%。在实施多方面、多学科干预措施之后，本研究旨在确定其对实现该目标的影响。
从2017年4月至2022年3月，对巴茨健康国民保健服务信托基金内连续的医院获得性菌血症住院患者进行前瞻性研究。采用质量改进方法，并在每个阶段实施计划、执行、研究、行动（PDSA）循环，对高风险手术的抗生素预防措施进行了修改，并引入了围绕医疗设备的“良好实践”干预措施。分析了菌血症患者的特征，并记录了菌血症发作的趋势。在Stata SE（版本16）中进行统计分析。
共有770例患者发生了797次医院获得性菌血症发作。在2017-2018年134次发作的基线之后，2019-2020年达到峰值194次，然后在2020-2021年降至157次，2021-2022年降至159次。大多数医院获得性菌血症发生在年龄>50岁的患者中，有551例（69.1%），其中比例最高的发生在年龄>70岁的患者中，有292例（36.6%）。医院获得性菌血症在10月至12月之间更为常见。大多数发作发生在内科或老年护理患者中，有345例（43.3%），专科手术患者中，有141例（17.7%），血液学/肿瘤学患者中，有127例（15.9%），以及需要重症监护的患者中，有108例（13.6%）。尿路是最常见的感染部位，有336例（42.2%），包括导管相关和非导管相关感染。175例（22.0%）菌血症分离株产超广谱β-内酰胺酶（ESB）。阿莫西林克拉维酸耐药率为315例（39.5%），环丙沙星耐药率为246例（30.9%），庆大霉素耐药率为123例（15.4%）。7天时，77例患者（9.7%；95%置信区间7.4-12.2%）死亡，到30天时，这一数字上升至129例（16.2%；95%置信区间13.7-19.9%）。
尽管实施了质量改进（QI）干预措施，但仍无法从基线水平降低50%，尽管从2019-2020年起实现了18%的降幅。我们的工作突出了抗菌预防和医疗设备“良好实践”的重要性。随着时间的推移，如果这些干预措施得到妥善实施，可能会进一步减少医疗保健相关菌血症感染。
