Update on infection prevention in the ICU.

IF 3.4 3区 医学 Q1 CRITICAL CARE MEDICINE
Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-08-07 DOI:10.1097/MCC.0000000000001313
Filippo Medioli, Erica Franceschini, Cristina Mussini, Marianna Meschiari
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引用次数: 0

Abstract

Purpose of review: Healthcare-associated infections (HAIs) remain a critical challenge in intensive care units (ICUs) due to the high prevalence of invasive procedures, vulnerable patient populations, and the increasing threat of antimicrobial-resistant organisms (MDROs). This review synthesizes current evidence on infection prevention and control (IPC) strategies in the ICU setting, highlighting recent findings and innovations in this evolving field, particularly in light of the impact of the COVID-19 pandemic.

Recent findings: The review outlines ten key IPC strategies for ICUs, categorizing them into horizontal (universal) and vertical (pathogen-specific) approaches. Recent literature emphasizes the importance of enhanced hand hygiene compliance through motivational interventions and feedback. The role of selective decontamination strategies remains debated, with evidence suggesting potential benefits in specific patient subgroups. Vertical strategies, including active screening for MDROs and per-pathogen bundles, are increasingly being tailored based on local epidemiology and pathogen characteristics. Studies suggest that de-escalating routine contact precautions for certain MDROs like Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus may be safe in settings with robust horizontal measures. Conversely, intensified "search and destroy" strategies show promise in controlling carbapenem-resistant Acinetobacter baumannii outbreaks.

Summary: Effective IPC in the ICU requires a multifaceted and adaptable approach, integrating both universal precautions and targeted interventions against specific pathogens. While consistent implementation of horizontal strategies like hand hygiene is foundational, tailoring vertical strategies based on local MDRO epidemiology and patient risk profiles is crucial. Future research should focus on harmonizing IPC policies, optimizing screening methods, and evaluating the long-term impact of combined IPC and antimicrobial stewardship programs to improve patient outcomes and mitigate the spread of antimicrobial resistance in critical care settings.

ICU感染预防的最新进展。
综述目的:由于侵入性手术的高流行率、易受伤害的患者群体以及耐药微生物(MDROs)日益增加的威胁,医疗保健相关感染(HAIs)仍然是重症监护病房(icu)的一个关键挑战。本综述综合了目前关于ICU感染预防和控制(IPC)策略的证据,重点介绍了这一不断发展的领域的最新发现和创新,特别是考虑到COVID-19大流行的影响。最新发现:该综述概述了icu的十项关键IPC策略,并将其分为水平(普遍)和垂直(病原体特异性)方法。最近的文献强调了通过动机干预和反馈增强手部卫生依从性的重要性。选择性去污策略的作用仍有争议,有证据表明在特定的患者亚组中有潜在的益处。纵向战略,包括主动筛查mdro和每病原体束,正越来越多地根据当地流行病学和病原体特征进行调整。研究表明,对某些耐甲氧西林金黄色葡萄球菌和万古霉素耐肠球菌等耐多药耐药抗生素采取逐步降级的常规接触预防措施,在采取强有力的水平措施的情况下可能是安全的。相反,强化的“搜索和破坏”策略显示出控制耐碳青霉烯鲍曼不动杆菌爆发的希望。摘要:ICU中有效的IPC需要采取多方面和适应性强的方法,将普遍预防措施和针对特定病原体的有针对性干预措施结合起来。虽然始终如一地实施手卫生等横向战略是基础,但根据当地MDRO流行病学和患者风险概况制定纵向战略至关重要。未来的研究应侧重于协调IPC政策,优化筛查方法,并评估IPC和抗菌素联合管理计划的长期影响,以改善患者预后并减轻重症监护环境中抗菌素耐药性的传播。
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
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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