比利时养老院医疗保健相关感染和抗菌药物使用:2010年至2016年三点患病率调查结果

Katrien Latour, Boudewijn Catry, Brecht Devleesschauwer, Frank Buntinx, Jan De Lepeleire, Béatrice Jans
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引用次数: 1

摘要

背景:比利时通过参与在长期护理设施(HALT调查)中组织的欧洲点患病率调查(pps)来监测护理相关感染(HAIs)和养老院(NHs)抗菌药物使用的负担。我们介绍了在NHs中进行的三个全国性pps的主要发现,这些pps至少参与了其中一个调查,并且参与了所有三个连续调查的队列。方法:在2010年5月- 9月(HALT-1)、2013年4月- 5月(HALT-2)或2016年9月- 11月(HALT-3),邀请所有NHs自愿参与调查。数据是在机构、病房和住院一级收集的。所有符合条件的居民(即,至少24小时以来一直住在该机构,上午8点到达并愿意参与)必须完成一份详细的问卷调查,这些居民在PPS当天接受了至少一种系统抗菌药物和/或至少有一种有效的HAI。体征/症状的发作必须发生在居民(重新)入住NH后48小时以上。结果:共有107家、87家和158家NHs分别进行了HALT-1、HALT-2和HALT-3调查。使用抗菌药物的居民中位患病率从HALT-1的4.3%(95%可信区间(CI): 3.5-4.8%)增加到HALT-2的4.7% (95% CI: 3.5-6.5%)和HALT-3的5.0% (95% CI: 4.2-5.9%)。HALT-1组HAI患者的中位患病率为1.8% (95% CI: 1.4-2.7%), HALT-2组为3.2% (95% CI: 2.2-4.2%), HALT-3组为2.7% (95% CI: 2.1-3.4%)。我们对队列(n = 25 NHs)的事后分析发现了类似的趋势。在所有三项调查中,呼吸道感染是最常见的报告,其次是HALT-1中的皮肤/伤口感染,以及HALT-2和HALT-3中的尿路感染。抗微生物药物是治疗感染最常用的处方:在HALT-1中为66.4%,在HALT-2中为60.9%,在HALT-3中为64.1%。尿预防用药分别占所有处方的28.7%、35.6%和28.4%。结论:尽管研究设计特有的局限性,pps使我们能够评估HAIs的发生并提高对地方和国家一级NHs中HAIs和合理抗菌药物使用的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Healthcare-associated infections and antimicrobial use in Belgian nursing homes: results of three point prevalence surveys between 2010 and 2016.

Healthcare-associated infections and antimicrobial use in Belgian nursing homes: results of three point prevalence surveys between 2010 and 2016.

Healthcare-associated infections and antimicrobial use in Belgian nursing homes: results of three point prevalence surveys between 2010 and 2016.

Background: Belgium monitors the burden of healthcare-associated infections (HAIs) and antimicrobial use in nursing homes (NHs) by participating in the European point prevalence surveys (PPSs) organised in long-term care facilities (HALT surveys). We present the main findings of the three national PPSs conducted in NHs participating in at least one of these surveys, and in a cohort that participated in all three consecutive surveys.

Methods: All NHs were invited to voluntarily participate and conduct the survey on one single day in May-September 2010 (HALT-1), in April-May 2013 (HALT-2) or in September-November 2016 (HALT-3). Data were collected at institutional, ward and resident level. A detailed questionnaire had to be completed for all eligible (i.e. living full time in the facility since at least 24 h, present at 8:00 am and willing to participate) residents receiving at least one systemic antimicrobial agent and/or presenting at least one active HAI on the PPS day. The onset of signs/symptoms had to occur more than 48 h after the resident was (re-)admitted to the NH.

Results: A total of 107, 87 and 158 NHs conducted the HALT-1, HALT-2 and HALT-3 survey, respectively. The median prevalence of residents with antimicrobial agent(s) increased from 4.3% (95% confidence interval (CI): 3.5-4.8%) in HALT-1 to 4.7% (95% CI: 3.5-6.5%) in HALT-2 and 5.0% (95% CI: 4.2-5.9%) in HALT-3. The median prevalence of residents with HAI(s) varied from 1.8% (95% CI: 1.4-2.7%) in HALT-1 to 3.2% (95% CI: 2.2-4.2%) in HALT-2 and 2.7% (95% CI: 2.1-3.4%) in HALT-3. Our post-hoc analysis on the cohort (n = 25 NHs) found similar trends. In all three surveys, respiratory tract infections were most frequently reported, followed by skin/wound infections in HALT-1 and urinary tract infections in HALT-2 and HALT-3. Antimicrobials were most commonly prescribed for the therapeutic treatment of an infection: 66.4% in HALT-1, 60.9% in HALT-2 and 64.1% in HALT-3. Uroprophylaxis accounted for 28.7%, 35.6% and 28.4% of all prescriptions, respectively.

Conclusions: None withstanding the limitations peculiar to the study design, the PPSs enabled us to assess the occurrence of and to increase awareness for HAIs and rational antimicrobial use in NHs at both local and national level.

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