投稿分類 其他

主委發表種類: 壁報

投稿標題(中): 加護病房多重抗藥性格蘭氏陰性菌感染之實證危險因子

投稿標題(英): Risk factors for multidrug‐resistant Gram‐negative bacteria infection in intensive care units

投稿摘要: Background:
Gram‐negative bacteria usually result in 4 common types of hospital‐acquired infection: pneumonia, surgical site infections, urinary tract infections (UTI), and bloodstream infections (BSI). Many studies have evaluated the results of multidrug‐resistant Gram‐negative bacteria (MDR‐GNB) induced infections, which can lead to high morbidity and to mortality of between 40% and 50% (Ozsurekci et al., 2017). MDR‐GNB infections are mainly transmitted through contact, most directly by the nurse. Thus, MDR‐GNB has gradually become a major threat to ICU nosocomial infection, leading to greater challenges for nursing. Understanding and mastering the relevant knowledge and skills can reduce the incidence and spread of MDR‐GNB infection. We herein sought to search for systematically integrated evidence to identify the risk factors for MDR‐GNB and provide suggestions and an evidence‐base for clinical measures.
Methods:
The terms multidrug‐resistant Gram‐negative bacteria, risk factors, intensive care units and the synonyms were used to formulate a PICO and were engaged as keywords to search Embase, Cochrane Library and PubMed to filter systematic review (SR) in priority. One relevant and latest (2018) SR, also meta-analysis was filtered out of 203 searching results in PubMed afterward for critical appraisal.
Results:
The SR involves 18 studies. Male gender: OR=1.40 ( 95%CI 1.09-1.80), having an operative procedure: OR=1.31(1.10-1.56), a central venous catheter: OR=1.22 (1.01-1.48), mechanical ventilation: OR=1.25 (1.07, 1.46), previous antibiotic therapy: OR =1.66 (1.41-1.96), length of ICU stay: WMD(weighted mean difference) = 8.18( 0.27- 16.10), and types of health‐associated infections were the identified risk factors for multidrug‐resistant Gram‐negative bacterial infection in intensive care units; however, diabetes mellitus was not the risk factors.
Conclusions:
Supporting evidence for judicious use of invasive surgery and of the importance of standardized antibiotic use, isolation measures, and bacterial monitoring to
prevent MDR‐GNB infection in the ICU was provided. Those findings can help clinical ICU doctors, nurses, and managers identify practices to reduce the risk of spread of infection, through hand hygiene and use of strict aseptic technique and other procedures; by adjusting use of mechanical ventilation and other invasive procedures, by standardization and control of antibiotic use, and effective management and supervision in ICUs.

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