投稿分類 其他

主委發表種類: 壁報

投稿標題(中): 成人加護病房預防與控制革蘭氏陰性菌之實證策略

投稿標題(英): Evidence-based Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units

投稿摘要: 前言
Multidrug-resistant gram-negative bacteria (MDR-GNB), including MDR Acinetobacter baumannii (MDR-AB), MDR Pseudomonas aeruginosa (MDR-PA), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem- resistant Enterobacteriaceae (CRE), are a major public health concern. The limited or even no effective treatment options make clinical management of MDR-GNB infections particularly challenging. We herein apply EBM methods to search meta-analyzed evidence to evaluate the relative efficacy of strategies for the prevention of MDR-GNB in adult intensive care units (ICUs).
方法
The terms: Multidrug Resistant Gram Negative Bacteria, Intensive Care Unit, Prevention or Control, were used as keywords to search studies published in 5 years in PubMed database. A 2017 published SR (systematic review) and network meta-analysis was acquired out of 252 searching results afterward for critical appraisal.
討論
The SR includes 42 studies (5 RCT and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9), and evaluated standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. The majority of studies reported ESBL–producing Enterobacteriaceae and MDR-AB. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention rate ratio (RR), 0.05 [95% confidence interval (CI), 0.01–0.38]. When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR-AB [RR, 0.28 (95% CI, 0.18–0.43) and 0.48 (95% CI, 0.35–0.66), respectively). Strategies with ASP as a core component showed a statistically significant reduction of the acquisition of ESBL-producing Enterobacteriaceae [RR, 0.28 (95% CI, 0.11–0.69)] for STD+ASP+ENV and 0.23 (95% CI, 0.07–0.80) for STD+ASP+DCL].
結論
A 4-component IPC strategy is the most effective intervention to prevent MDR-GNB acquisition in adult ICU patients. Through EBM appraisal of the present SR, we suggest that infection preventionists adopt effective interventions per the assessment of infrastructure and resource availability.

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