烧伤患者耐碳青霉烯类革兰阴性杆菌感染干预措施效果研究

Effects of interventions to carbapenem-resistant gram-negative bacilli infection in burn patients

  • 摘要: 目的 探究多方面干预策略在烧伤患者耐碳青霉烯类革兰阴性杆菌医院感染管理中的作用效果。方法 回顾性分析2016年1月-2017年12月多方面干预前后中国科学院大学宁波华美医院烧伤科1 316例患者总抗菌药物和碳青霉烯类药物累计日处方协定剂量(DDDs)、抗菌药物使用强度(AUD)以及耐碳青霉烯类革兰阴性杆菌的检出率、多耐药革兰阴性杆菌感染发现率,其中2016年1月1日-12月31日为干预前组,2017年1月日1日-12月31日为干预后组。结果 干预后总抗菌药物DDDs、碳青霉烯类药物DDDs分别为519.55、33.88,与干预前497.78、42.88比较,无统计学差异;干预后总抗菌药物AUD、碳青霉烯类药物AUD分别由72.88 、8.72降至56.52、3.20(P<0.05);干预后耐碳青霉烯类铜绿假单胞菌、耐碳青霉烯类肺炎克雷伯菌检出率分别由95.08%、87.50%降至6.25%、53.45%(P<0.05);干预后烧伤科患者院感发病率由12.88%降至12.08%,无统计学差异,多耐药铜绿假单胞菌感染发现率由2.01%降至0.26%(P=0.001)。结论 多方面干预策略可以显著降低烧伤患者总抗菌药物AUD及碳青霉烯类药物AUD,减少耐碳青霉烯类革兰阴性杆菌检出率和感染发现率。

     

    Abstract: OBJECTIVE To explore the effect of a multifaceted intervention strategy on control of carbapenem-resistant gram-negative bacilli infections in burn patients. METHODS The cumulative daily prescription agreement dose (DDDs) of antibiotics and carbapenems, antibiotic use density (AUD), isolation rates of carbapenem-resistant gram-negative bacilli and incidence of multidrug-resistant gram-negative bacilli infection of 1 316 patients who were treated in Hawmei Hospital, University of Chinese Academy of Sciences from Jan 2016 to Dec 2017 were retrospectively analyzed before and after the multifaceted intervention strategy was implemented. The time period from Jan 1, 2016 to Dec31, 2016 were assigned as the pre-intervention group, and the time period from Jan 1, 2017 to Dec 31,2017 were set as the post-intervention group. RESULTS The DDDs of total antibiotics and carbapenems were respectively 519.55 and 33.88 after the intervention and were respectively 497.78 and 42.88 before the intervention, and there were no significant differences. The AUDs of total antibiotics and carbapenems respectively dropped from 72.88 and 8.72 to 56.52 and 3.20 after the intervention(P<0.05). The isolation rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae respectively dropped from 95.08% and 87.50% to 6.25% and 53.45% after the intervention(P<0.05). The incidence of nosocomial infection in the patients of burn departments declined from 12.88% to 12.08% after the intervention, and there was no significant difference; the discovery rate of multidrug-resistant P.aeruginosa infection dropped from 2.01% to 0.26% (P=0.001). CONCLUSION The multifaceted intervention strategy may significantly reduce the AUDs of total antibiotics and carbapenems and the isolation rate of carbapenem-resistant gram-negative bacilli as well as the discovery rate of infection.

     

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