Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.
Objective To evaluate the effect of active screening and intervention of multidrug-resistant organisms (MDROs) on control nosocomial infection in the general intensive care unit (ICU). Methods A non-concurrent control trial was conducted in patients hospitalized in the ICU for more than 24 hours in the Second Affiliated Hospital of Fujian Medical University. Patients underwent active screening of MDROs for nasal vestibular swab, throat swab and rectal swab combined with further intensive intervention for patients with positive screening result during Sept. 2014 to Aug. 2015 were included as an intervention group, patients only underwent active screening during Sept. 2013 to Aug. 2014 were included as a screening group, and patients without undergoing active screening during Sept. 2012 to Aug. 2013 were as a control group. SPSS 19.0 software was used to compare the hospital infection rate and the infection rate of MDROs among the three groups. Results A total of 1 773 patients were included, of which 655 patients were in the intervention group, 515 patients were in the screening group, and 603 patients were in the control group. The difference of hospital infection rates among the three groups was statistically significant (χ2=21.087, P < 0.001), and further pairwise comparison results showed that the intervention group was lower than the screening group (χ2=5.891, P=0.015), and the screening group was lower than the control group (χ2=4.259, P=0.039). The adjustment daily infection rate of the intervention group, screening group and control group were 6.69‰, 10.88‰, and 15.39‰, respectively. The difference of MDROs hospital infection rates among the three groups was statistically significant (χ2=21.039, P < 0.001), and further pairwise comparison results showed that the intervention group was lower than the screening group (χ2=5.936, P=0.015), and the screening group was lower than the control group (χ2=5.798, P=0.016). The MDROs thousand daily infection rate of the intervention group was lower than that of the screening group (3.90‰ vs. 7.30‰, χ2=5.999, P=0.014). Conclusion The active screening plus intensive intervention of MDROs can effectively reduce the incidence rates of nosocomial infections and MDROs infections in ICU.
Objective To evaluate the effect of ECRS management model on the quality of prevention and control of hospital infection with multidrug-resistant organisms (MDROs). Methods The data related to the prevention and control of MDROs in the First Hospital of Nanchang in 2020 and 2021 were retrospectively collected. The hospital implemented routine MDRO infection prevention and control management in accordance with the Expert Consensus on the Prevention and Control of Multi-drug Resistant Bacteria Nosocomial Infection in 2020. On this basis, the hospital applied the four principles of the ECRS method to cancel, combine, rearrange and simplify the MDRO infection prevention and control management. The detection rate of MDROs on object surfaces, the incidence rate of hospital infection of MDROs, the compliance rate of hand hygiene, the implementation rate of contact isolation prevention and control measures, and the pass rate of MDRO infection prevention and control education assessment were analyzed and compared between the two years. Results The detection rate of MDROs on the surfaces in 2021 was lower than that in 2020 (9.39% vs. 31.63%). The hospital-acquired MDRO infection rate in 2021 was lower than that in 2020 (1.18% vs. 1.46%). The hand hygiene compliance rates of medical staff, workers and caregivers in 2021 were higher than those in 2020 (90.99% vs. 78.63%, 73.51% vs. 45.96%, 70.96% vs. 33.71%). The implementation rate of contact isolation prevention and control measures in 2021 was higher than that in 2020 (93.31% vs. 70.79%). The qualified rates of MDRO infection prevention and control education in medical personnel, workers and caregivers in 2021 were higher than those in 2020 (96.57% vs. 81.31%, 76.47% vs. 47.95%, 73.17% vs. 34.19%). All the differences above were statistically significant (P<0.05). Conclusion ECRS management mode can improve the execution and prevention level of MDRO hospital infection prevention and control, and reduce the incidence of MDRO hospital infection.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.
ObjectiveTo optimize procedures of going out for examination for patients with multidrug-resistant organism, strengthen prevention and control management of nosocomial infection, and prevent nosocomial infection.MethodsPatients with multidrug-resistant organism who went out for examination were selected from April to November 2018. April to July 2018 (before implementation) was process construction stage, and August to November 2018 (after implementation) was process optimization implementation stage. In April 2018, process and management system of going out for multidrug-resistant organism patients were formulated, training of transporters was strengthened, and measures such as checklist identification, accompany patients for examination, patient handover, isolation and protection, and disinfection of materials were implemented, to realize the infection prevention and control management in the whole process of going out for multidrug-resistant organism patients. We compared relevant indicators before and after implementation.ResultsA total of 262 cases times of patients with multidrug-resistant organism were included, including 134 cases times before implementation and 128 cases times after implementation. Compared with before implementation, the hand hygiene, wearing gloves, disinfection of inspection instruments and articles, patient transfer, isolation measures in waiting process (special elevator, isolation after waiting for inspection, arrange inspection time reasonably), education and training after implementation improved(P<0.05). Before and after implementation, the Methicillin resistant staphylococcus aureus detection rate difference was statistically significant (P<0.05).ConclusionsThe optimization of procedures of examination for patients with multidrug-resistant organism can increase implementation rate of indirect indicators such as hand hygiene, disinfection of inspection instruments and articles, isolation and protection, education and training in the prevention and control of multidrug-resistant organism in nosocomial infection. And it is important for the prevention and control of multi-disciplinary collaboration of multidrug-resistant organism.
Objective To explore the source and distribution of patients with multidrug resistant organisms (MDROs) acquired (infections/colonizations) outside the hospital and to provide a reference for guiding proactive interventions for nosocomial transmission of MDROs. Methods Bacterial culture results and clinical data of patients newly admitted to Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospita1 were retrospectively investigated between January 1st 2022 and December 31st 2023. The types of MDROs infections/colonizations, patient sources, and triple distributions of patients with nosocomial acquisition of MDROs were analyzed. Results A total of 293 patients with 308 infections/colonizations were investigated in the extranocomial infection of MDROs, 198110 newly admitted patients during the same period, and the total case rate of extranocomial infection of MDROs was 0.155% (308/198110). Among them, the case rate of extranocomial infection of methicillin-resistant Staphylococcus aureus (0.062%) and carbapenem resistant Acinetobacter baumannii (0.044%) were higher than those of other types of bacteria. The case rate of extranocomial infection of MDROs was statistically significant in terms of the distribution of the route of admission, gender of the patient, age of the patient, department of admission, and time of admission (P<0.001); The distribution of patients with extranocomial infection of various types of MDROs was correlated with admission route, patient age, and admission department (P<0.001), and the associations with patient gender and admission time were not statistically significant (P>0.05). Conclusions The total case rate of extranocomial infection of MDROs in the institution was at a relatively low level, and conducting large-scale active screening has certain limitations. Active screening factors should be considered in a comprehensive manner to capture differences in epidemiological characteristics of patients with extranocomial infection of MDROs, and targeted prevention and intervention should be carried out to achieve a reduction in infections from MDROs in hospitals.
Diabetic foot infection (DFI) is one of the main causes of hospitalized patients with diabetic foot. DFI should be diagnosed according to the clinical manifestations, and the severity of infection should be graded in time. Diabetic foot wounds are mostly chronic wounds, and there are many kinds of bacterial infections. The bacteria and antibiotics resistance will change with the progress of the disease. Bacterial biofilm is also one of the important causes of antibiotic resistance. Reasonable and timely surgical treatment combined with effective antibiotic treatment is an effective measure to deal with the challenge of DFI. On this basis, multidisciplinary cooperation will achieve the best clinical outcome.
Objective To investigate the value of bronchial mucosa biopsy and quantitative culture in the differential diagnosis of lower airway bacterial colonization and infection. Methods A prospective observational cohort survey onMDR Pseudomonas aeruginosa and Acinetobacter baumannii was carried out in intubed or tracheotomized patients with invasive ventilation in respiratory intensive care unite ( RICU) . A total of 50 ICU patients were followed for the detection of MDR pathogen colonization or infection from June 2008 to October 2009. All subjects were divided into an infection group and a colonization group according to the outcome of patients discharged fromthe RICU. Baseline information, APACHEⅡ scores, and CPIS scores were recorded on individual forms for each patient untill discharge or death. Bronchial mucosa biopsy was conducted on appropriate time to identify whether the patient was comfirmed as infection. Microbiological diagnosis was performed with quantitative culture. Results Fifty patients were enrolled in this study, of which infected in 23 cases and colonized in 27 cases. The time of invasive mechanical ventilation, length ofICU stay, catheter indwelling time, and the kinds of disease were significantly different between the two groups( P lt; 0. 05) . The kinds of using antibiotics before onset of multi-drug resistance of bacteria showed that cefoxitin/ cefmetazole and mezlocillin also had significant difference between the infection group and the colonization group. The results of dynamic CPIS score of the infection group showed that scores at each timepoint were higher than those in the colonization group. However, the results of t-test showed that there was higher score in the infection group than that in the colonization group on 14 days after intubation ( P lt;0. 05) . The bronchial mucosa biopsy showed that airway inflammation was detected in 19 cases in the infection group and 9 cases in colonization group. The positive rate in the infection and the colonization group were 55. 6% and 25. 0% , respectively assessed by traditional threshold of 103 cfu/mL for PSB in quantitative bacterial culture. In addition, there was more inflammatory cells in the patients with drug-resistant pathogens infection than that in the patients without nosocomial infection. The combination of bronchial mucosa biopsy and microorganism quantitative cultures had the highest sensitivity and specificity and the highest diagnostic accuracy. Conclusions Bronchial mucosa biopsy combining microorganism quantitative culture is feasible in identifying colonized or infected bacteria. Invasive mechanical ventilation time, length of ICU stay and the catheter indwelling time extending are risk factors for bacterial colonization.
Objective To investigate the changes of multidrug-resistant organisms (MDROs) in the First People’s Hospital of Longquanyi District of Chengdu around its overall relocation. Methods The First People’s Hospital of Longquanyi District of Chengdu was overall relocated on December 31st, 2016. The detection rates of MDROs and the changes in nosocomial infections before the relocation (from 2015 to 2016) and after the relocation (from 2017 to 2020) were retrospectively analyzed. Results A total of 83634 qualified specimens were submitted for inspection, 8945 strains of pathogenic bacteria were detected, and the detection rate of pathogenic bacteria was 10.70%, showing an increasing trend in yearly detection rates of pathogenic bacteria (χ2trend=8.722, P=0.003); among them, 1551 MDRO strains were detected, and the detection rate of MDROs was 17.34%, showing an increasing trend in yearly detection rates of MDROs (χ2trend=11.140, P=0.001). The detection rate of pathogenic bacteria before relocation was lower than that after relocation, and the difference was statistically significant (9.64% vs. 11.08%; χ2=35.408, P<0.001); there was no significant difference in the detection rate of MDROs before and after relocation (16.32% vs. 17.66%; χ2=2.050, P=0.152). From 2015 to 2020, the detection rates of pathogenic bacteria from sputum+throat swab specimens (χ2trend=81.764, P<0.001) and secretion+pus specimens (χ2trend=56.311, P<0.001) showed increasing trends, while the detection rates of pathogenic bacteria from blood specimens (χ2trend=110.400, P<0.001), urine specimens (χ2trend=11.919, P=0.001), and sterile body fluid specimens (χ2trend=20.158, P<0.001) showed decreasing trends. The MDRO detection rates of Escherichia coli (χ2trend=21.742, P<0.001), Staphylococcus aureus (χ2trend=47.049, P<0.001), and Pseudomonas aeruginosa (χ2trend=66.625, P<0.001) showed increasing trends, while the MDRO detection rates of Klebsiella pneumoniae (χ2trend=2.929, P=0.087) and Acinetobacter baumannii (χ2trend=0.498, P=0.481) showed no statistically linear trend, but the MDRO detection rate of Acinetobacter baumannii dropped significantly in 2017. In the targeted monitored MDROs, the proportions of nosocomial infections in methicillin-resistant Staphylococcus aureus (χ2trend=4.581, P=0.032), carbapenem-resistant Enterobacteriaceae (χ2trend=8.031, P=0.005), and carbapenem-resistant Pseudomonas aeruginosa (χ2trend=6.692, P=0.010) showed decreasing trends; there was no statistically linear trend in the proportion of nosocomial infections in carbapenem-resistant Acinetobacter baumannii (χ2trend=0.597, P=0.440); only one strain of vancomycin-resistant Enterococcus was detected in 2017, and no nosocomial infection occurred. Conclusions The overall detection rate of pathogenic bacteria and MDROs in this tertiary general hospital around relocation showed increasing trends year by year. The detection rate of pathogenic bacteria after relocation was higher than that before relocation, but the detection rate of MDROs after relocation did not differ from that before relocation. The proportion of nosocomial infections among the targeted monitored MDROs decreased.