Active follow-up of patients identified with multidrug-resistant Gram-negative bacteria to discontinue contact precautions and isolation measures

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2024-07-31 DOI:10.1016/j.jhin.2024.07.008

C.P. Haanappel, A.F. Voor in ‘t holt, I. de Goeij, W. de Groot, J.A. Severin, M.C. Vos, L.G.M. Bode

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引用次数: 0

Abstract

Background

It is essential to refrain from unnecessary isolation measures indicated for patients identified with multidrug-resistant Gram-negative bacteria (MDR-GNB).

Aim

To evaluate whether a pro-active follow-up strategy to discontinue isolation measures of patients identified with MDR-GNB (without carbapenemase production) resulted in reduced isolation days during hospitalization, compared to passive follow-up.

Methods

A comparison was made between active and passive follow-up strategies over a two-year period after first MDR-GNB identification. Patients could be declared negative after two consecutive negative screening cultures. Active follow-up patients received a questionnaire for screening cultures within six months of MDR-GNB identification. Of the 2208 patients included, 1424 patients (64.5%) underwent passive follow-up and 784 patients (35.5%) underwent active follow-up.

Findings

A significantly higher proportion of active follow-up patients who had sufficient (at least two) screening cultures were declared MDR-GNB negative compared to those with passive follow-up; 66.9% vs 20.6% (P < 0.001) for adult patients and 76.0% vs 17.1% (P < 0.001) for paediatric patients. A comparison between active follow-up patients with sufficient versus those with active follow-up but insufficient cultures revealed a reduction of isolation days for paediatric patients (median 10.6 vs 1.6 days; P = 0.031). Though this difference was not statistically significant for adults (median 5.3 vs 4.2 isolation days), there was a valuable decrease in the number of isolation days for both adult and paediatric patients under active follow-up with sufficient (≥2) cultures, indicating clinical relevance.

Conclusion

We recommend an active follow-up strategy for patients identified with an MDR-GNB, to prevent further unneeded infection prevention measures.

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积极跟进被确认患有耐多药革兰氏阴性菌的患者，停止接触预防措施和隔离措施。

因此，本研究旨在评估主动随访策略与被动随访相比，是否能减少住院期间的隔离天数，主动随访策略能终止对已确定为耐多药革兰氏阴性菌（MDR-GNB）患者（不产生碳青霉烯酶）的隔离措施。在首次发现 MDR-GNB 后的两年内，对主动和被动随访策略进行了比较。患者在筛查培养结果连续两次阴性后可被宣布为阴性。主动随访患者在 MDR-GNB 鉴定后 6 个月内收到筛查培养问卷。在纳入的 2208 名患者中，1424 名患者（64.5%）接受了被动随访，784 名患者（35.5%）接受了主动随访。与被动随访的患者相比，主动随访的患者中，有足够（至少两次）筛查培养的患者被宣布为 MDR-GNB 阴性的比例明显更高；66.9% 对 20.6%（P

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.