Schechner Vered, Cohen Adi, Carmeli Yehuda
National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.
School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Open Forum Infect Dis. 2024 May 28;11(6):ofae301. doi: 10.1093/ofid/ofae301. eCollection 2024 Jun.
We examined temporal trends in carbapenem-resistant (CRAB) infections in a hospital with hyperendemic CRAB and assessed the efficacy of varied infection control strategies in different ward types.
We retrospectively analyzed all CRAB clinical samples from 2006 to 2019 and categorized infections as hospital-onset (HO) or community-onset. We used interrupted time series analysis to assess the impact of interventions on the incidence of all HO-CRAB infections and bloodstream infections (BSIs) at the hospital and ward group levels.
Over 14 years, 4009 CRAB infections were identified (89.7% HO), with 813 CRAB BSI (93.2% HO). The incidence per 100 000 patient-days of CRAB infections peaked in 2008 at 79.1, and that of CRAB BSI peaked in 2010 at 16.2. These rates decreased by two-thirds by 2019. In the general intensive care unit (ICU), hand hygiene and environmental cleaning interventions were followed by a significant reduction in the level of HO-CRAB infections, with an additional decrease in the slope after the introduction of active surveillance and 2% chlorhexidine bathing. In the surgical ICU and surgical department, a reduction in slope or level of CRAB infection was observed after moving ventilated patients to single rooms. In medical wards, a multimodal intervention was followed by a reduction in the slope of HO-CRAB infections and BSIs. In wards where CRAB infections were uncommon, the incidence of HO-CRAB infections decreased throughout the study period.
Ward-specific variables determine the success of interventions in reducing CRAB infections; therefore, interventions should be tailored to each setting.
我们研究了一家耐碳青霉烯类鲍曼不动杆菌（CRAB）高度流行医院中CRAB感染的时间趋势，并评估了不同感染控制策略在不同病房类型中的效果。
我们回顾性分析了2006年至2019年所有CRAB临床样本，并将感染分为医院获得性（HO）或社区获得性。我们使用中断时间序列分析来评估干预措施对医院和病房组层面所有HO-CRAB感染及血流感染（BSI）发病率的影响。
在14年期间，共识别出4009例CRAB感染（89.7%为HO），其中813例为CRAB BSI（93.2%为HO）。每10万患者日的CRAB感染发病率在2008年达到峰值，为79.1，CRAB BSI发病率在2010年达到峰值，为16.2。到2019年，这些发病率下降了三分之二。在普通重症监护病房（ICU），手卫生和环境清洁干预措施实施后，HO-CRAB感染水平显著降低，在引入主动监测和2%洗必泰沐浴后斜率进一步下降。在外科ICU和外科科室，将机械通气患者转移至单人病房后，CRAB感染的斜率或水平有所下降。在内科病房，多模式干预措施实施后，HO-CRAB感染和BSI的斜率下降。在CRAB感染不常见的病房，整个研究期间HO-CRAB感染的发病率均有所下降。
特定病房的变量决定了干预措施在减少CRAB感染方面的成功与否；因此，干预措施应根据每种情况进行调整。
