Rumbak M J, Cancio M R
Division of Pulmonary, Critical Care and Occupational Medicine, Vencor-Tampa Hospital, FL, USA.
Crit Care Med. 1995 Jul;23(7):1200-3. doi: 10.1097/00003246-199507000-00008.
To determine whether the institution of a methicillin-resistant Staphylococcus aureus prevention protocol was associated with a decrease in methicillin-resistant S. aureus ventilator-associated pneumonia in long-term, acute care ventilator patients.
A retrospective chart review comparing the number of episodes of clinical pneumonia per patient ventilator day in the 12 months preceding and 24 months following the introduction of the protocol.
University affiliated, long-term, acute care ventilator hospital.
Long-term, acute care ventilated patients who presented with clinical pneumonia.
Addition of a methicillin-resistant S. aureus prevention protocol. In addition to universal precautions, the protocol consisted of mupirocin 2% ointment applied to the anterior nares, and whole body washing with chlorhexidine. All patients were given mupirocin and chlorhexidine twice weekly. Patients were cohorted in the same room if they were, or had been, infected or colonized with methicillin-resistant S. aureus in any anatomical location or at any time. This procedure replaced strict isolation of methicillin-resistant S. aureus-infected or colonized individuals.
Clinical pneumonia was diagnosed when a patient developed fever, bronchorrhea, increased white blood cell count, methicillin-resistant S. aureus isolated from the tracheal aspirate, and new or increasing infiltrate on chest roentgenograph. During the 12 months preceding the protocol, there were 0.2% episodes of methicillin-resistant S. aureus ventilator-associated pneumonia per ventilated patient day compared with 0.026% in the 24 months after the protocol (p < .001). The relative and absolute risk reductions associated with the introduction of the protocol were 87% and 6, respectively.
The period following the institution of the protocol showed a significant reduction in episodes of clinical pneumonia compared with the 12-month period preceding the use of the protocol (p < .001). Thus, we conclude that the introduction of this protocol is associated with a significant decrease in methicillin-resistant S. aureus ventilator-associated pneumonia.
确定耐甲氧西林金黄色葡萄球菌预防方案的实施是否与长期急性护理呼吸机患者中耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎的减少有关。
一项回顾性图表审查，比较该方案引入前12个月和引入后24个月每位患者呼吸机日的临床肺炎发作次数。
大学附属医院，长期急性护理呼吸机医院。
出现临床肺炎的长期急性护理呼吸机患者。
增加耐甲氧西林金黄色葡萄球菌预防方案。除了通用预防措施外，该方案包括在前鼻孔涂抹2%莫匹罗星软膏，并用洗必泰进行全身清洗。所有患者每周接受两次莫匹罗星和洗必泰治疗。如果患者在任何解剖部位或任何时间感染或定植有耐甲氧西林金黄色葡萄球菌，则将他们安置在同一房间。此程序取代了对耐甲氧西林金黄色葡萄球菌感染或定植个体的严格隔离。
当患者出现发热、支气管分泌物增多、白细胞计数增加、从气管吸出物中分离出耐甲氧西林金黄色葡萄球菌以及胸部X线片上新发或加重的浸润影时，诊断为临床肺炎。在该方案实施前的12个月中，每例通气患者每日发生耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎的发生率为0.2%，而在该方案实施后的24个月中为0.026%（p<0.001）。与该方案引入相关的相对和绝对风险降低分别为87%和6。
与使用该方案前的12个月相比，该方案实施后的时期临床肺炎发作次数显著减少（p<0.001）。因此，我们得出结论，该方案的引入与耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎的显著减少有关。
