Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model_West China Medical Journal

Authors：

ZUO Yan ¹ , LIU Jing ² ,  CHEN Yanan ²

1. Department of Nursing Management, the First People’s Hospital of Lianyungang, Lianyungang, Jiangsu 222061, P. R. China;
2. Department of Infection Management, the First People’s Hospital of Lianyungang, Lianyungang, Jiangsu 222061, P. R. China;

Corresponding?author：

CHEN Yanan, Email: 297769987@qq.com

Keywords：

Old age; transparent supervision; carbapenem resistant Gram-negative bacilli; effect

DOI：

10.7507/1002-0179.202401013

Video：

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Objective To explore the prevention and control effect of carbapenem resistant Gram-negative bacillus (CRO) in geriatric ward based on transparent supervision model. Methods Patients admitted to the geriatric ward in the First People’s Hospital of Lianyungang between January 2018 and December 2022 were selected. A transparent regulatory model for CRO was established and implemented in 2019, including the establishment of a regulatory group, the development of cluster prevention and control measures, the implementation of transparent reminder, publicity, supervision and assessment and other management measures. We evaluated the effectiveness by comparing the detection rate and infection rate of CRO before and after the intervention. Results A total of 15015 patients were monitored, and a total of 418 strains of CRO were detected. The incidence rate of noso-comial infection was decreasing year by year（χ²=26.666, P<0.001), and the etiological submission rate of hospitalized patients before antimicrobial treatment had been increasing year by year（χ²=280.320, P<0.001). The detection rate of CRO infection had been decreasing year by year, but the difference was not statistically significant (P>0.05), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia infection (P=0.030). The detection rate of CRO had been decreasing year by year (χ²=33.593, P<0.001), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia (χ²=23.663, P<0.001) and carbapenem resistant Pseudomonas aeruginosa (χ²=14.527, P=0.006).Conclusions By establishing and promoting transparent supervision mode in the geriatric ward, the detection rate and infection rate of drug-resistant bacteria can be significantly reduced, and the prevention and control effect of CRO in the elderly patients in the ward can be effectively improved to ensure the safety of elderly patients.

Citation： ZUO Yan, LIU Jing, CHEN Yanan. Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model. West China Medical Journal, 2024, 39(3): 387-391. doi: 10.7507/1002-0179.202401013 Copy

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2.	許川, 賴曉全, 徐敏, 等. 多學科協作管理模式提高住院患者抗菌藥物治療前病原學送檢率的應用效果. 中華醫院感染學雜志, 2023, 33(21): 3321-3326.
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10.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 8(5): 314-320.
11.	楊欣雨, 王惠, 呂宇, 等. 2018-2022 年四川省醫院醫院感染現況調查. 中華醫院感染學雜志, 2023, 33(21): 3201-3206.
12.	Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
13.	吳安華. 醫院感染控制當前面臨的嚴峻挑戰及對策. 華西醫學, 2019, 34(3): 227-232.
14.	李穎, 許文, 戈偉, 等. 提高多重耐藥菌防控措施執行力對降低多重耐藥菌醫院感染的影響. 中國感染控制雜志, 2017, 16(2): 126-129.
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16.	Hansen S, Schwab F, Zingg W, et al. Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 – results of the PROHIBIT study. Euro Surveill, 2018, 23(21): 1700513.
17.	劉衛平, 海云婷, 郭天慧, 等. 老年患者醫院感染現狀調查及病原菌耐藥分析. 中華醫院感染學雜志, 2018, 28(11): 1645-1649.
18.	臧鳳, 張永祥, 劉波, 等. 重癥監護病房老年患者多藥耐藥菌的感染分布與來源分析. 中華醫院感染學雜志, 2020, 30(6): 866-871.
19.	陳惠剛, 李桂艷, 馬微. 老年下呼吸道感染銅綠假單胞菌的病原學特征分析. 中國病原生物學雜志, 2024, 19(1): 74-78.
20.	Chu VT, Tsitsiklis A, Mick E, et al. The antibiotic resistance reservoir of the lung microbiome expands with age. Res Sq, 2023: rs. 3. rs-3283415.
21.	尹丹萍, 徐茂云, 朱田田, 等. 某醫院老年患者多重耐藥菌感染臨床分布特點. 中國消毒學雜志, 2023, 40(8): 585-587.
22.	全國細菌耐藥監測網. 全國細菌耐藥監測網 2014—2019 年老年患者常見臨床分離細菌耐藥性監測報告. 中國感染控制雜志, 2021, 20(2): 112-123.
23.	劉娜, 王娜娜, 紀冰, 等. 2012—2021 年住院老年患者感染病原菌分布及耐藥趨勢. 山東大學學報(醫學版), 2023, 61(6): 29-40, 46.
24.	Gómez-Zorrilla S, Camoez M, Tubau F, et al. Prospective observational study of prior rectal colonization status as a predictor for subsequent development of Pseudomonas aeruginosa clinical infections. Antimicrob Agents Chemother, 2015, 59(9): 5213-5219.
25.	Le Guern R, Grandjean T, Stabler S, et al. Gut colonisation with multidrug-resistant Klebsiella pneumoniae worsens Pseudomonas aeruginosa lung infection. Nat Commun, 2023, 14(1): 78.
26.	Madden GR, Sifri CD. Antimicrobial resistance to agents used for Staphylococcus aureus decolonization: is there a reason for concern? Curr Infect Dis Rep, 2018, 20(8): 26.
27.	Song X, Soghier L, Floyd TT, et al. Reassessing the need for active surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the neonatal intensive care population. Infect Control Hosp Epidemiol, 2018, 39(12): 1436-1441.

1. Guidelines for the prevention and control of carbapenem-resistant enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization, 2017.
2. 許川, 賴曉全, 徐敏, 等. 多學科協作管理模式提高住院患者抗菌藥物治療前病原學送檢率的應用效果. 中華醫院感染學雜志, 2023, 33(21): 3321-3326.
3. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325): 629-655.
4. 胡付品, 郭燕, 朱德妹, 等. 2021 年 CHINET 中國細菌耐藥監測. 中國感染與化療雜志, 2022, 22(5): 521-530.
5. 喬甫, 宗志勇. 世界衛生組織《醫療機構耐碳青霉烯的腸桿菌科細菌、銅綠假單胞菌和鮑曼不動桿菌防控指南》介紹. 華西醫學, 2018, 33(3): 259-263.
6. 殷希, 杜鑫, 楊詩汝, 等. 美英兩國醫療領域透明監管制度對我國合理用藥監管的啟示. 醫學與社會, 2014, 27(9): 11-14.
7. 鄭曉菲, 張新平, 賴曉全, 等. 基于德爾菲法的醫院感染公開指標研究. 中國醫院管理, 2016, 36(5): 59-61.
8. 梁艷芳, 賴曉全, 譚莉. 透明監管在醫院感染管理中的應用研究. 中華醫院感染學雜志, 2020, 30(1): 135-140.
9. 黃勛, 鄧子德, 倪語星, 等. 多重耐藥菌醫院感染預防與控制中國專家共識. 中國感染控制雜志, 2015, 14(1): 1-9.
10. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 8(5): 314-320.
11. 楊欣雨, 王惠, 呂宇, 等. 2018-2022 年四川省醫院醫院感染現況調查. 中華醫院感染學雜志, 2023, 33(21): 3201-3206.
12. Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
13. 吳安華. 醫院感染控制當前面臨的嚴峻挑戰及對策. 華西醫學, 2019, 34(3): 227-232.
14. 李穎, 許文, 戈偉, 等. 提高多重耐藥菌防控措施執行力對降低多重耐藥菌醫院感染的影響. 中國感染控制雜志, 2017, 16(2): 126-129.
15. Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med, 2007, 357(16): 1573-1575.
16. Hansen S, Schwab F, Zingg W, et al. Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 – results of the PROHIBIT study. Euro Surveill, 2018, 23(21): 1700513.
17. 劉衛平, 海云婷, 郭天慧, 等. 老年患者醫院感染現狀調查及病原菌耐藥分析. 中華醫院感染學雜志, 2018, 28(11): 1645-1649.
18. 臧鳳, 張永祥, 劉波, 等. 重癥監護病房老年患者多藥耐藥菌的感染分布與來源分析. 中華醫院感染學雜志, 2020, 30(6): 866-871.
19. 陳惠剛, 李桂艷, 馬微. 老年下呼吸道感染銅綠假單胞菌的病原學特征分析. 中國病原生物學雜志, 2024, 19(1): 74-78.
20. Chu VT, Tsitsiklis A, Mick E, et al. The antibiotic resistance reservoir of the lung microbiome expands with age. Res Sq, 2023: rs. 3. rs-3283415.
21. 尹丹萍, 徐茂云, 朱田田, 等. 某醫院老年患者多重耐藥菌感染臨床分布特點. 中國消毒學雜志, 2023, 40(8): 585-587.
22. 全國細菌耐藥監測網. 全國細菌耐藥監測網 2014—2019 年老年患者常見臨床分離細菌耐藥性監測報告. 中國感染控制雜志, 2021, 20(2): 112-123.
23. 劉娜, 王娜娜, 紀冰, 等. 2012—2021 年住院老年患者感染病原菌分布及耐藥趨勢. 山東大學學報(醫學版), 2023, 61(6): 29-40, 46.
24. Gómez-Zorrilla S, Camoez M, Tubau F, et al. Prospective observational study of prior rectal colonization status as a predictor for subsequent development of Pseudomonas aeruginosa clinical infections. Antimicrob Agents Chemother, 2015, 59(9): 5213-5219.
25. Le Guern R, Grandjean T, Stabler S, et al. Gut colonisation with multidrug-resistant Klebsiella pneumoniae worsens Pseudomonas aeruginosa lung infection. Nat Commun, 2023, 14(1): 78.
26. Madden GR, Sifri CD. Antimicrobial resistance to agents used for Staphylococcus aureus decolonization: is there a reason for concern? Curr Infect Dis Rep, 2018, 20(8): 26.
27. Song X, Soghier L, Floyd TT, et al. Reassessing the need for active surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the neonatal intensive care population. Infect Control Hosp Epidemiol, 2018, 39(12): 1436-1441.

West China Medical Journal

Study on prevention and control effect of carbapenem resistant Gram-negative bacilli in geriatric ward based on transparent supervision model

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