目的:评估多模式介入项目(“零耐药”)对患者ICU住院期间多药耐药菌(MDR-B)获取的影响。
方法:前瞻性,开放标签,介入,多中心研究。
方法:103个ICU。
方法:重症患者在27个月内进入ICU。
方法:实施10项建议,以防止MDR-B在ICU中的出现和传播。
未经证实:患者在ICU住院期间获得MDR-B的比率,区分定植和感染。
结果:共纳入139,505例患者。在5409名(3.9%)患者中,6020MDR-B在ICU入院时被确定,在3648名(2.6%)患者中,在ICU住院期间分离出4269例新的MDR-B。在研究期间,入院时检测到的MDR-B患者的比率显着增加(IRR1.43,95%CI1.31-1.56)(p<0.001),初始和最终每月费率增加了32.2%。相反,在ICU住院期间,MDR-B患者的发生率无明显下降(IRR0.93,95%CI0.83-1.03)(p=0.174),初始和最终每月费率下降24.9%。根据定植或感染的分类,入院时检测到MDR-B定植显著增加(IRR1.69,95%CI1.52-1.83;p<0.0001),ICU住院期间MDR-B感染显著减少(IRR0.67,95%CI0.57-0.80,p<0.0001).
结论:实施ZR项目建议与患者ICU期间获得的MDR-B产生的感染显著减少相关。
To assess the impact of a multimodal interventional project (\"Zero Resistance\") on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient\'s ICU stay.
Prospective, open-label, interventional, multicenter study.
103 ICUs.
Critically ill patients admitted to the ICUs over a 27-month period.
Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU.
Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection.
A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31-1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83-1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52-1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57-0.80, p<0.0001).
The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient\'s ICU stay.