重症监护病房耐多药细菌定植的风险因素。

Yolanda Garcia-Parejo, Jesus Gonzalez-Rubio, Jesus Garcia Guerrero, Ana Gomez-Juarez Sango, Jose Miguel Cantero Escribano, Alberto Najera
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引用次数: 0

摘要

导言:抗菌药耐药性是一项重大的公共卫生挑战,世界卫生组织已将其视为全球医疗保健领域亟待解决的问题。重症监护病房(ICU)的患者尤其容易受到耐多药微生物(MDROs)的定植和/或感染:通过重点研究初始定植和病原菌定植,确定混合重症监护病房和复苏病房中 MDROs 定植的流行病学特征和风险因素:描述性观察研究,包含分析要素。研究使用了阿尔瓦塞特综合大学医院(西班牙)预防医学服务处在 2016 年 4 月至 2021 年 12 月期间进行的零耐药性登记。研究确定了MDROs定植的风险因素:结果:在 7541 个病例中,61.0% 的病例在最初定植时存在 MDROs 的风险因素,而 34.0% 的病例在住院时未定植 MDROs(p 结论:最初定植 MDROs 的风险因素显著高于未定植 MDROs 的风险因素:过去 3 个月内≥ 5 天的住院、之前的 MDROs 定植/感染和住院是首次定植 MDROs 的重要风险因素。重症监护室住院时间越长,病菌定植风险越高:本研究强调了早期识别和管理重症监护病房中存在MDROs定植风险的患者的重要性。通过识别各种因素(如既往住院情况、现有定植或感染情况、ICU住院时间过长的影响),医疗服务提供者可以实施有针对性的策略来减少MDROs的传播,如加强监测、采取严格的感染控制措施和合理使用抗生素。我们的研究结果凸显了在重症监护环境中采用综合方法管理抗菌药物耐药性的必要性,以最终改善患者的治疗效果并减轻医院中 MDROs 的负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk factors for colonisation by Multidrug-Resistant bacteria in critical care units.

Introduction: Antimicrobial resistance is a major public health challenge recognised by the WHO as an urgent global healthcare concern. Patients in Intensive Care Units (ICUs) are particularly prone to colonisation and/or infection by multidrug-resistant organisms (MDROs).

Objectives: Delineate the epidemiological characteristics and risk factors for MDROs colonisation in mixed ICUs and Resuscitation Units by focusing on initial and nosocomial colonisation.

Material and methods: A descriptive observational study with analytical elements. It uses the Zero-Resistance register from the Preventive Medicine Service of the Albacete General University Hospital (Spain) from April 2016 to December 2021. It identifies the risk factors for MDROs colonisation.

Results: Of 7,541 cases, 61.0 % with initial colonisation had risk factors for MDROs versus 34.0 % not colonised upon hospitalisation (p < 0.001). Significant risk factors for initial colonisation included hospitalisation for ≥ 5 days within the last 3 months, prior MDROs colonisation/infection and institutionalization. No significant risk factor differences were found for nosocomial colonisation. An association between longer ICU stays and nosocomial colonisation (p < 0.001) was noted.

Conclusions: Significant risk factors for initial MDROs colonisation were hospitalisation for ≥ 5 days in the last 3 months, prior MDROs colonisation/infection and institutionalisation. Longer ICU stays increased the nosocomial colonisation risk.

Implications for clinical practice: This study underscores the importance to early identify and manage patients at risk for MDROs colonisation in ICUs. By recognising factors (i.e. previous hospitalisations, existing colonisation or infection, impact of prolonged ICU stay), healthcare providers can implement targeted strategies to mitigate the spread of MDROs; e.g. enhanced surveillance, stringent infection control measures and judicious antibiotics use. Our findings highlight the need for a comprehensive approach to manage antimicrobial resistance in critical care settings to ultimately improve patient outcomes and reduce MDROs burden in hospitals.

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