Analysis of risk factors of multidrug-resistant organism infection in lung transplant recipients based on restricted cubic spline model / 器官移植

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gram-negative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenem-resistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, long-time urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P < 0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P < 0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients.

Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections

Abstract INTRODUCTION: The present study aimed to determine the incidence of health care-associated infections (HCAIs) and identify the main resistant microorganisms in intensive care unit (ICU) patients in a Brazilian university hospital. METHODS: A retrospective cohort study was conducted in a Brazilian teaching hospital between 2012 and 2014. RESULTS: Overall, 81.2% of the infections were acquired in the ICU. The most common resistant pathogenic phenotypes in all-site and bloodstream infections were oxacillin-resistant coagulase-negative staphylococci and carbapenem-resistant Acinetobacter spp. (89.9% and 87.4%; 80.6% and 70.0%), respectively. CONCLUSIONS: There is an urgent need to focus on HCAIs in ICUs in Brazil.

Intraventricular Antimicrobial Therapy in children with Multi-Drug Resistant Ventriculitis: A tertiary hospital experience and literature review

Background@#Intraventricular antimicrobial therapy (IVT), defined as the direct installation of antimicrobial agents into the lateral ventricles has been utilized as the last therapeutic option for the treatment of multidrug-resistant ventriculitis. The aim of this case series is to report our institution’s experience with IVT in pediatric patients with ventriculitis. @*Material and Methods@#Retrospective chart review was done. The demographic data, cerebrospinal fluid (CSF) culture isolates, treatment regimens, and clinical outcomes of these patients were collected and described. @*Results@#Between 2016 to 2018, seven (7) pediatric patients diagnosed with ventriculitis caused by multidrug-resistant organisms underwent intraventricular antimicrobial therapy in combination with intravenous therapy. The median age was 1 year (range 1 month to 17 years old, mean: 4.4 years). Fifty-seven (57) percent of the patients were females. The isolated pathogens were Acinetobacter baumannii MDRO (n = 3), Klebsiella pneumoniae MDRO (n = 2), Methicillin-resistant Staphylococcus aureus (n = 1), and Methicillin-resistant Staphylococcus epidermidis (n = 2).One patient had mixed isolates on CSF culture (Acinetobacter baumannii and MRSE). The antimicrobial agents for IVT used were colistin (n = 4), vancomycin (n = 2), and gentamicin (n = 1). The mean time to initiation of intraventricular therapy from the diagnosis of ventriculitis was 19 days. The mean duration of IVT therapy was 15 days. The survival rate was 57%. @*Conclusion@#Ventriculitis caused by drug-resistant organisms is an emerging concern. Optimal therapy is not yet established and experience with IVT is limited. This series showed that there were no adverse effects related to IVT thus it may be considered an option for MDRO ventriculitis. Gram negative organisms are more common causes of ventriculitis in our institution.

How to deal with severe challenge of healthcare-associated infection due to multidrug-resistant organisms / 中国感染控制杂志

In recent years, with the widespread use of broad-spectrum antimicrobial agents, multidrug-resistant organisms (MDROs) have emerged and become more and more common, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE), which pose severe challenge to clinical anti-infective treatment and prevention and control of healthcare-associated infection. The new antimicrobial agents and bacterial resistance have developed at the same time, development of bacterial resistance seems to have a tendency to overwhelm the development of antimicrobial agents. Antimicrobial resistance (AMR) is now recognized as one of the major threat to human health worldwide. The Center for Disease Control and Prevention (CDC) of America has proposed four core plans to address the challenge of MDROs: surveillance, antimicrobial management, improvement of antimicrobial agents and diagnosis, as well as prevention and control of transmission. In response to the severe threat of MDRO infection, prevention of infection should be focused on, antimicrobial management and HAI management should be grasped at the same time and attached sufficient importance, effective measures should be taken based on the source, route, and susceptible people of infection, multiple details and constant innovation should be paid attention to, the final victory can be achieved.

Current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use / 中国感染控制杂志

Objective To investigate current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use.Methods Fourteen provinces (municipalities), autonomous regions and army hospitals in seven regions of China were selected, the participation of clinical microbiological laboratories in the consultation of HAI diseases, specimen quality control, antimicrobial use, and management of multidrug-resistant organisms (MDROs) before 2000 and every five years from 2000 to 2015 were investigated, the surveyed results were analyzed statistically.Results A total of 187 hospitals were investigated, in 2015, 96 and 172 hospitals (51.34％, 91.98％) participated in the consultation of infectious diseases and multi-department collaborative management on MDROs respectively.However, 44 hospitals (23.53％) still manually performed statistical analysis on drug susceptibility, only 26 hospitals (13.90％) had the ability of identifying homology of pathogens.Rate of MDRO surveillance data feedbacked to clinical departments increased from 66.84％ (n=125) in 2010 to 95.72％ (n=179) in 2015, the frequency of feedback was mainly monthly and quarterly;rate of antimicrobial susceptibility results feedbacked to clinic departments increased from 62.03％ (n=116) to 94.12％ (n=176), 82.35％ (n=154) of clinical microbiological laboratories conducted quarterly feedback;the quality control rate of microscopic sputum smear before sputum culture increased from63.10％ (n=118) to 87.17％ (n=163);rate of bilateral double blood culture increased from 35.83％ (n=67) to 72.73％ (n=136);rates of other aseptic body fluid culture (except blood and urine) increased from 4.86％ to 5.74％;differences were all significantly different between 2010 and 2015 (all P＜0.05).Conclusion Clinical microbiological laboratories have played an important role in promoting the development of HAI management in China, especially during the period of 2011-2015.However, the homology analysis on HAI pathogens, informatization of result feedback, and sterile body fluid specimens detection need to be further strengthened.

Application of transparent supervision in the multidrug-resistant organism management / 中华医院管理杂志

Objective@#To explore the practice and effect of transparent supervision in the prevention and control of multidrug-resistant organism (MDRO).@*Methods@#Transparent supervision was introduced to intervene into the MDRO management of monitored departments. Such transparent supervision was aided by IT means, and transparent MDRO control indexes. These indexes included hand hygiene compliance rate, qualification rate of ATP detection of environmental object surface, implementation rate of main MDRO prevention and control measures, MDRO resistance rate, and nosocomial infection incidence. The data before and after the intervention were compared by Chi square test to evaluation the effect.@*Results@#After intervention, the hand hygiene compliance rate increased from 49.83% to 65.61% (χ2=47.389, P<0.001), and the qualification rate of ATP detection of environmental object surface increased from 48.50% to 83.33% (χ2=96.115, P<0.001). Meanwhile, such indexes as prescription of patient isolation, placement of isolation identifiers and that of specialized bedside equipments increased significantly(P<0.001). The MDRO detection rate decreased from 75.08% to 63.31% (χ2=28.123, P<0.001), and the incidence of nosocomial infection decreased from 4.77% to 3.47%(χ2=20.303, P<0.001).@*Conclusions@#The practice of transparent supervision could reduce the risk of MDRO transmission at hospitals effectively, proving its importance in ensuring medical quality and patient safety.

Killing efficacy of a medical disinfection ultrasonic coupling agent on five kinds of multidrug-resistant organisms / 中国感染控制杂志

Objective To observe the efficacy of a medical disinfectant ultrasonic coupling agent on the killing of five clinically isolated multidrug-resistant organisms(MDROs).Methods From March 2016 to May 2017,a disin-fection ultrasonic coupling agent containing active ingredient,including triclosan and propylene glycol,was used to conduct carrier quantitative germicidal test on five clinically isolated MDROs,the killing efficacy to MDROs was ob-served.Results After 1.5,3.0,and 4.5 minute disinfection time,the killing logarithms values of disinfection ultra-sonic coupling agent to five MDROs(multidrug-resistant Acinetobacter bau m annii[MDR-AB],methicillin-resistant Staphylococcus aureus[MRSA],multidrug-resistant Pseudomonas aeruginosa[MDR-PA],carbapenem-resistant Klebsiella pneumoniae[CRKP],and extended-spectrum β-lactamase Escherichia coli[ESBLs-EC])were all>3.0. Conclusion Medical disinfection ultrasonic coupling agent can effectively kill five common MDROs,and can take the place of disinfectant during ultrasonic examination.

Application of PDCA cycle in the hospital management of multidrug-resistant organisms / 中国感染控制杂志

Objective To analyze the change in isolation rates of multidrug-resistant organisms (MDROs) before and after adopting plan-do-check-act (PDCA) cycle method for management of MDROs. Methods Bacterial culture specimen submission and isolation of MDROs in a tertiary first-class hospital before the implementation of PDCA cycle (January 2013-December 2014) and after implementation of PDCA cycle (January 2015-December 2016) were collected and analyzed. Results A total of 14 889 specimens were sent for detection before the implementation of PDCA cycle, 6 345 strains were isolated, 650 of which were MDROs, isolation rate of MDROs was 10. 24％; after the implementation of PDCA cycle, 17 856 specimens were sent for detection, 7 568 strains were isolated, 476 were MDROs, isolation rate of MDROs was 6.29％; difference in MDRO detection rate before and after the implementation of PDCA was statistically significant (X2=72.567, P＜0.001). After Cochran-Armitage trend test, the isolation rates of MDROs in 2013-2016 showed a decreased trend (Z= - 7.8856). The amount and cost of hand hygiene products have increased. Conclusion By carrying out PDCA cycle for MDROs management, the isolation rate of MDROs in hospital is reduced. PDCA cycle management method can effectively promote the continuous quality improvement of hospital MDROs management.

Prevention of multidrug-resistant organism infection through chlorhexidine gluconate rubbing bathing in patients in intensive care unit / 中国感染控制杂志

Objective To study the effect of chlorhexidine gluconate rubbing bathing on preventing multidrug-resistant organism(MDRO)infection in patients in intensive care unit(ICU).Methods 108 critically ill patients in a tertiary first-class hospital between January and December 2016 were randomly divided into trial group and control group.Trial group adopted wet towel containing 2％ chlorhexidine gluconate for bathing, control group adopted water for bathing.Bacteriostasis rate, incidence of healthcare-associated infection(HAI), occurrence of MDRO infection, and adverse reaction between two groups of patients after rubbing bathing were compared.Results There was no significant difference in the bacteriostasis rate within 2 hours between two groups(P＞0.05), bacteriostasis rates of trial group after 4, 8, and 24 hours of bathing were significantly higher than control group(P＜0.001).Incidences of HAI in trial group and control group were 44.44％(24/54)and 66.67％(36/54)respectively(P＜0.05); incidences of MDRO infection in trial group and control group were 20.37％(11/54)and 40.74％(22/54)respectively(P＜0.05).The main infection sites in trial group and control group were both lower respiratory tract, accounting for 87.50％and72.22％respectively;8 cases(33.33％)in trial group and11(30.55％)in control group had ventilator-associated pneumonia(VAP).11 strains of MDROs in trial group and 22in control group were isolated, both were mainly carbapenem-resistant Acinetobacter baumannii (CRAB).There was no adverse reaction after the bathing in both groups.Conclusion Application of chlorhexidine gluconate bathing can effectively reduce the incidence of HAI and MDRO infection in ICU patients.

Effect of business process reengineering on multisectors' participation in prevention and control of multidrug-resistant organism infection / 中国感染控制杂志

Objective To investigate the effect of business process reengineering(BPR)on improving multisectors'participation in management of multidrug-resistant organism(MDRO)infection, and provide methodological guidance for hospital multisectors'collaborative management.Methods Related data about management and disposal of 672 cases of MDRO infection occurred from July 2015 to June 2017 were selected, 370 patients before BPR (from July2015to June 2016)were as control group, 302 patients after BPR(from July2016to June 2017)were as a trial group, BPR was used to improve the process of detection, report, cooperation, and disposal of MDROs in hospital, various quality evaluation indexes of healthcare-associated infection before and after BPR were compared. Results After the BPR was implemented, time of MDRO information transmitted from laboratory to clinical departments shortened from(240±30)minutes to(8±2)minutes;incidence of MDRO HAI decreased from2.39‰to 1.56‰, isolation rate of MDROs decreased from13.42％ to 11.09％, differences were all significant(all P＜ 0.05).Compliance rates and awareness rates of various MDRO prevention and control measures increased from 58.11％-71.89％to 84.11％-92.05％, usage rate of antimicrobial agents decreased from53.18％to 48.45％, defined daily doses(DDDs)of antimicrobial use density decreased from44.76 to 38.26, specimen submission rate before antimicrobial use increased from46.68％to 53.62％.Conclusion BPR can enhance the cooperation between different departments, give full play to the complementary advantages of interdisciplinary, and improve the efficiency of HAI management.

Difference in detection results and antimicrobial resistance of multidrug-resistant organisms in intensive care unit and non-intensive care unit / 中国感染控制杂志

Objective To understand detection results and difference in multidrug-resistant organisms(MDROs) in intensive care unit(ICU)and non-ICU.Methods Strains isolated from clinical specimens of hospitalized patients in a hospital from January 2015 to December 2016 were analyzed, 6 kinds of MDROs were conducted targeted monitoring, isolation and antimicrobial resistance of 6 kinds of MDROs from ICU and non-ICU patients were compared. Results A total of 1 013 strains of 6 kinds of MDROs were monitored, isolation rate was13.13％.Isolation rate of MDROs in ICU was higher than that of non-ICU (24.60％vs 5.47％, P＜0.001).Carbapenem-resistant Acinetobacter baumannii(CRAB)was the main isolated MDROs, accounting for 69.40％;of different pathogenic organisms, isolation rate of CRAB was the highest(55.75％).The main MDROs detected in ICU and non-ICU were both CRAB, accounting for 76.32％and 48.62％respectively;Of isolated pathogens, isolation rate of MDROs in ICU was higher than that of non-ICU(47.95％vs 8.02％, P＜0.001).Antimicrobial resistance rates of Escherichia coli isolated from ICU to ticarcillin/clavulanic acid, ceftriaxone, cefotaxime, cefepime, imipenem, meropenem, amikacin, and gentamicin were all higher than that of non-ICU, resistant to piperacillin was lower than non-ICU, difference was statistically significant(all P≤0.05);resistance rates of Klebsiella pneumoniae from ICU to common antimicrobial agents(except piperacillin)were all higher than non-ICU(all P＜0.05).Resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa from ICU to common antimicrobial agents were all higher than non-ICU (all P＜0.05).Resistance rates of Staphylococcus aureus isolated from ICU to oxacillin, ciprofloxacin, tetracycline, and rifampicin were all higher than non-ICU (all P＜0.05), and resistance rates of Enterococcus faeciumto quinupristin/dafoeleptin and tetracycline were both lower than non-ICU (both P＜0.05).Conclusion Isolation rate of MDROs in ICU is high, resistance rates to most antimicrobial agents are also higher than non-ICU, monitoring on MDROs in ICU should be strengthened, and according prevention and control measures should be formulated.

Application of PDCA cycle management method in prevention and control of multidrug-resistant organisms / 中国感染控制杂志

Objective To evaluate the effect of plan-do-check-act (PDCA) cycle management method on improving multidrug-resistant organisms (MDROs) prevention and control measures.Methods PDCA cycle management method was applied to improve the management system and management process of a hospital,prevention and control efficacy of MDROs in clinic departments between July-December 2014 (before PDCA implementation) and January-June 2015 (after PDCA implementation) was compared.Results After half a year implementation of PDCA cycle management,the total implementation rate of MDROs prevention and control measures increased from 57.14％ (360/630) to 79.69％ (510/640),difference was statistically significant(P＜0.05);implementation rate of recording by doctors during the disease course,recording by nurses during the nursing process,registration and reporting of MDROs,as well as posting isolation signs were all improved,difference was statistically significant (all P＜0.05).The total isolation rate of MDROs declined from 30.65％ (347/1 132)before PDCA implementation to 22.61％ (236/1 044) after PDCA implementation,difference was statistically significant (x2 =10.393,P＜0.05).Conclusion Application of PDCA cycle can improve the prevention and control measures of MDROs.

Effect of multi-disciplinary team combined with bundle management on prevention of multidrug-resistant organism infection in the intensive care unit / 中国感染控制杂志

Objective To explore the effect of multi-disciplinary team (MDT) combined with bundle management on prevention and control of multidrug-resistant organism (MDRO) infection in the intensive care unit(ICU).Methods Patients who were admitted to the ICU in a tertiary first-class hospital from January 2013 to December 2015 were studied,MDT combined with bundle management has been applied in the prevention and control of MDRO infection in ICU since January 2014,continuous quality improvement program was performed one year later,isolation of MDROs from specimens of ICU patients before implementation(in the year of 2013),after implementation(in the year of 2014),and after continuous quality improvement(in the year of 2015) was compared.Results The infection rates of MDROs in ICU patients before implementation,after implementation,and after continuous quality improvement were 26.55％ (154/580),17.13％ (117/683),and 12.01％ (77/641) respectively,showing a downward trend,with a significant difference (x2 =44.030,P＜0.001);the total isolation rates of MDROs in ICU patients were 64.44％(154/239),63.59％(117/184),and 43.26％ (77/178) respectively,showing a downward trend,with a significant difference (x2 =22.284,P＜0.001).The main MDROs in ICU were multidrug-resistant (MDR) and pandrug resistant(PDR) Acinetobacterbaumannii (44.54％).Conclusion MDT combined with bundle management can decrease MDRO infection rate and isolation rate in ICU.

Analysis of Risk Factors for Nosocomial Infection of Multidrug-resistant Organism in ICU / 中国药房

OBJECTIVE:To explore the risk factors for nosocomial infection of multidrug-resistant organism (MDRO) in ICU,and to provide reference for preventing and controlling MDRO in ICU. METHODS:In retrospective study,246 patients with nosocomial infection from ICU of Xi'an Aerospace General Hospital (hereinafter referred to asour hospital) during Jan. 2011-Dec. 2015 were selected and divided into non-MDRO infection group (140 cases) and MDRO infection group (106 cases). The detection and drug resistance of MDRO were analyzed in MDRO group. Univariate analysis and binary Logistic regression anal-ysis were used to explore risk factors for nosocomial infection of MDRO. RESULTS:During 2011-2015,435 strains of MDRO were isolated from 106 MDRO infection patients,in which Gram-negative bacteria accounted for 89.43%,showing severe drug re-sistance. Univariate analysis showed that the following 13 factors were related to nosocomial infection of MDRO,such as ICU ad-mission time,hypoproteinemia,acute cerebrovascular diseases,renal abnormalities,mechanical ventilation time,arterivenous cath-eterization time,urethral catheterization time,indwelling gastric tube time,type and time of using antibiotics,combined use of an-tibiotics,application of carbapenems and the third generation caphalosporins(P<0.05). Binary Logistic regression analysis showed that acute cerebrovascular diseases,type and time of using antibiotics were the independent risk factors for nosocomial infection of MDRO in ICU [odds ratios were 2.816,1.582,1.265,95%CI were (1.540,5.151),(1.085,2.306),(1.131,1.415)]. CONCLU-SIONS:Some prevention and control measures should be taken actively for high-risk MDRO infection patients in ICU to reduce the incidence of nosocomial infection of MDRO and improve the quality of health care.

Efficacy of targeted monitoring and intervention on multidrug-resistant organisms in intensive care units / 中国感染控制杂志

Objective To understand the status of infection with multidrug-resistant organisms (MDROs) in intensive care units(ICUs),and evaluate the intervention efficacy of targeted monitoring.Methods Prospective study was adopted,patients who were admitted to ICUs in 2014-2015 were selected (January-December 2014 was as preintervention stage,January-December 2015 was as intervention stage),trend of MDRO infection before and after intervention were compared and analyzed.Results Before and after intervention,297 and 217 strains of MDROs were isolated respectively,except carbapenem-resistant Pseudomonasaeruginosa (CRPA),the isolated strains of carbapenem-resistant Acinetobacterbaunannii (CRAB),carbapenem-resistant Enterobacteriaceae (CRE),methicillin-resistant Staphylococcus aureus(MRSA),and vancomycin-resistant Enterococcus (VRE) declined after intervention.MDRO infection rate declined from 7.17 ％ before intervention to 3.88％ after intervention,infection rate of CRAB and CRE after intervention were both lower than before intervention (both P＜0.05);MDRO infection rates in general ICU and internal medicine ICU increased from 8.75％ and 7.84‰ before intervention to 4.39‰ and 2.28％ after intervention,respectively (both P＜0.05).After taking comprehensive intervention measures,compliance to prevention and control measures,such as ordering rate of doctor's advice on contact isolation for 24 hours,hand hygiene,health care workers' awareness all enhanced significantly(all P＜0.05).Conclusion Targeted monitoring and intervention measures can reduce isolation rate of MDROs in ICUs.

Prevalence of Multidrug Resistant Organisms in Inter-Hospital Transferred Critically Ill Patients

PURPOSE: To assess the prevalence of multidrug-resistant organisms (MDROs) in inter-hospital transferred critically ill patients. METHODS: This is a retrospective study. The study population comprised patients who were transferred from other hospitals or health care units into the medical or surgical intensive care unit of Samsung Medical Center from January 2012 to December 2014. We evaluated the acquisition of clinically significant MDROs including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria, and carbapenem- resistant Gram-negative bacteria (CRGNB). RESULTS: Three hundred and twenty-one patients were included in this study. One hundred and fifty-one patients (47.0%) had at least one species of MDRO, 21.5% in MRSA, 27.1% in VRE, 15.6% in CRGNB, and 3.7% in ESBL. The prevalence of MDROs was significantly higher in male (52.7%), patients with diabetes (61.6%), patients with combined infectious diseases (51.6%), and medical patients (49.3%). Patients with MRSA had significantly longer length of stay than the patients without MRSA. The patients with CRGNB had higher mortality than the patients without CRGNB. CONCLUSION: The prevalence of MDROs in inter-hospital transferred critically ill patients was very high. Patients with MDROs in this study had longer hospital stay and higher mortality. These patients require more attention for isolation and hygiene protocols, and antibiotic choices.

Effect of carbapenem exposure on isolation rate of multidrug-resistant organisms and prognosis of elderly patients with severe pneumonia / 中国感染控制杂志

Objective To evaluate the effect of carbapenem exposure on isolation rate of multidrug resistant organisms(MDROs) and prognosis of elderly patients with severe pneumonia.Methods Elderly patients with severe pneumonia and admitted to the intensive care unit in a hospital between February 2014 and February 2016 were investigated retrospectively.According to whether there was carbapenem exposure,patients were divided into group A(carbapenem exposure group) and group B(carbapenem non exposure group).Patients in group A were subdivided into two subgroups according to exposure time of carbapenems,group A1 received carbapenems for＞7 days,group A2 received carbapenems for ≤7 days.The isolation rates of MDROs,mechanical ventilation days,length of stay in ICU,and 28 day mortality among groups were compared and analyzed.Results A total of 86 patients were enrolled in the investigation,57 were males and 29 were females;the average age was (80.12 + 10.45) years (range:65-92 years).There were 40 cases in group A,46 in group B;24 cases in group A1,and 16 in group A2.The isolation rates of MDROs in group A and group B were 65.00％ and 36.96％ respectively,difference was sta tistically significant(P＜0.05);Comparison between two groups of patients revealed that mechanical ventilation days,length of stay in ICU,and 28 day mortality in group A were all higher than group B,difference was statistically significant(all P＜0.05);the isolation rates of MDROs in group A1 was higher than group A2 (75.00％ vs 43.75％,P＜0.05)；mechanical ventilation days of group A1 was higher than group A2 ([7.69 ± 2.22]d vs [6.34±-1.56]d,P＜0.05);28-day mortality and length of stay in ICU between group A1 and A2 were not significantly different(both P＞0.05).Conclusion Carbapenem exposure can increase the occurrence of MDRO infection,especially the non-fermentative bacterial colonization or infection,and prolong the mechanical ventilation days and length of stay in ICU,thus affect the prognosis of patients.

Current situation of multidrug-resistant organism infection and efficacy of bundle intervention measures in a tertiary first-class hospital / 中国感染控制杂志

Objective To understand the current situation of multidrug-resistant organism (MDRO)infection in hospitalized patients in a tertiary first-class hospital,as well as efficacy of bundle intervention measures on preven-tion and control of infection. Methods Hospitalized patients who were infected with MDROs in this hospital during 2012-2014 were monitored and conducted bundle intervention. Results In 2012-2014,a total of 1909 MDRO strains were isolated. The isolation rates of MDROs in 2012-2014 were 30.69% ,31 .04% ,and 29.40% respec-tively,bedside intervention rates were 81 .02% ,92.05% ,and 94.23% respectively,implementation rates of clinical isolation were 69.97% ,82.98% ,and 93.04% respectively;MDRO isolation rates during 2012-2014 were not sig-nificantly different(P>0.05);bedside intervention rates and implementation rates of clinical isolation were both sig-nificantly different(both P<0.05). The top 3 isolated MDROs in 2012-2014 were extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli,multidrug-resistant Acinetobacter baumannii,and ESBLs-producing Klebsiel-lapneumoniae. Conclusion Bundle intervention measures,such as multi-department collaboration and strengthened on-site supervision,can promote more standardized management of healthcare-associated infection,enhance the im-plementation rate of clinical isolation,and effectively prevent and control the spread of MDRO in hospital.

Meta-analysis on risk factors for healthcare-associated infection with mul-tidrug-resistant Acinetobacter baumannii / 中国感染控制杂志

Objective To systematically evaluate risk factors for healthcare-associated infection(HAI)with multi-drug-resistant Acinetobacterbaumannii (MDRAB),so as to provide scientific basis for formulating MDRAB pre-vention and intervention strategies. Methods Literatures at home and abroad were searched,RevMan 5.3 statisti-cal software was used for meta analysis of the included literature data. Results A total of 21 papers were included, 8 in English and 13 in Chinese,35 risk factors were analyzed,20 of which were significantly different(all P<0.05),which included in 4 categories:① Related factors for antimicrobial use:use of antimicrobial agents prior to isolation of MDRAB(OR,12.87 [95% CI,5.14-32.21]),duration of antimicrobial use(MD,6.99 [95% CI, 2.21-11.78]),types of used antimicrobial agents (MD,1.07 [95% CI,0.60-1.54]),combined use of antimi-crobial agents(OR,4.16 [95% CI,2.63-6.57]),carbapenems use(OR,3.95 [95% CI,2.54-6.13]),use of third and above generation cephalosporins(OR,2.48 [95% CI,1.90-3.24]);② Related factors for invasive pro-cedures:mechanical ventilation(OR,4.30 [95% CI,3.03- 6.10]),endotracheal intubation/tracheotomy(OR, 4.17 [95% CI,2.41-7.22]),urinary catheterization(OR,2.35 [95% CI,1.42-3.88]),deep venous puncture (OR,2.18 [95% CI,1.14-4.16]),drainage catheterization(OR,2.06 [95% CI,1.19-3.58]);③Related fac-tors for intensive care unit (ICU):ICU admission(OR,5.60 [95% CI,2.73-11.48]),length of ICU stay(MD, 4.21 [95% CI,0.72-7.71]);④ Other factors:heart disease(OR,0.71 [95% CI,0.55-0.93]),tumor(OR, 0.67 [95% CI,0.48-0.95]),pancreatitis(OR,2.04 [95% CI,1.11-3.76]),mixed infection(OR,2.57 [95%CI,1.78-3.71]),length of hospital stay(MD,5.92 [95% CI,3.61-8.23]),APACHE II score(MD,4.56 [95% CI,1.94-7.18]),use of glucocorticoid(OR,2.18 [95% CI,1.21-3.90]). Conclusion Antimicrobial use,invasive operation,ICU-related factors are the main risk factors for MDRAB HAI,the relevant treatment and nursing intervention strategies should be formulated based on risk factors to prevent and reduce MDRAB infection.

Effect of improving compliance to multidrug-resistant organism prevention and control measures on reducing MDRO healthcare-associated infection / 中国感染控制杂志

Objective To understand the effect of improving compliance rate to multidrug-resistant organism (MDRO)prevention and control measures on reducing MDRO transmission in the intensive care unit (ICU ). Methods All patients in 5 ICUs of a hospital in March-June 2014 were chosen,March 1-April 30,2014 was base-line survey stage,May 1-June 30,2014 was intervention stage (comprehensive intervention measures were taken), the implementation of patients contact isolation measures,as well as awareness of MDRO-related knowledge among health care workers(HCWs)in 5 ICUs before and after intervention were compared respectively. Results HCWs' awareness rates of MDRO transmission modes,contact isolation measures,and informing of department transfer after intervention were all higher than before intervention(100.00% vs 67.22% ,98.89% vs 61.11% ,93.33% vs 45 .56% ,respectively);except single-room isolation,compliance rates to other prevention and control measures (including doctor's advice on isolation,bedside isolation,wearing isolation gowns,adding isolation logo)were all higher than before intervention(>70% vs <50% ,all P<0.01). Detection rate of MDROs after intervention was lower than before intervention (7.16% [90/1257]vs 9.65% [117/1212],χ2= 5.00,P= 0.03). Conclusion Com-prehensive intervention measures can improve HCWs'compliance to prevention and control measures on MDROs, and reduce the transmission of MDROs.