Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis_West China Medical Journal

Authors：

GUO Linwen ^1,2 , HUANG Wenzhi ^1,2 , ZENG Ni ³ ,  QIAO Fu ^1,2

1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Infection Control, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 561113, P. R. China;

Corresponding?author：

QIAO Fu, Email: qiaofu2005@scu.edu.cn

Keywords：

Carbapenem-resistant organism; prevention; control; meta-analysis

DOI：

10.7507/1002-0179.202402163

Video：

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Objective To evaluate the efficiency of prevention and control strategies of carbapenem-resistant organism (CRO) in medical institutions in China using meta-analysis method. Methods PubMed, Embase, Medline (Ovid), Web of Science, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Database were systematically searched for studies on CRO prevention and control in Chinese medical institutions from the establishment of databases to 2023 for meta-analysis. Results A total of 21 studies were included, consisting of 3 randomized controlled studies and 18 non-randomized controlled studies. The meta-analysis results showed that compared with standard prevention and control measures, strengthened intervention measures (including active screening, information-based transparent supervision mode, comprehensive intervention, and bundled prevention and control strategies) could effectively reduce the CRO infection rate [relative risk (RR)=0.40, 95% confidence interval (CI) (0.25, 0.65), P<0.05]. Proactive screening could effectively reduce the CRO infection rate [RR=0.52, 95%CI (0.30, 0.91), P<0.05] and carbapenem-resistant Enterobacteriaceae (CRE) infection rate [RR=0.47, 95%CI (0.24, 0.93), P<0.05]. Information-based transparent supervision could reduce the CRE infection rate by improving compliance with standard prevention and control measures [RR=0.42, 95%CI (0.28, 0.62), P<0.05]. Conclusions Compared with standard prevention and control measures, strengthened intervention measures can effectively reduce the risk of in-hospital transmission and infection of CRO. In clinical practice, bundled comprehensive intervention can be combined with information-based transparent supervision, and if necessary, proactive screening of CRO in high-risk populations should be carried out.

Citation： GUO Linwen, HUANG Wenzhi, ZENG Ni, QIAO Fu. Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis. West China Medical Journal, 2024, 39(3): 392-398. doi: 10.7507/1002-0179.202402163 Copy

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1. Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis, 2018, 18(3): 318-327.
2. Jiang Y, Ding Y, Wei Y, et al. Carbapenem-resistant Acinetobacter baumannii: a challenge in the intensive care unit. Front Microbiol, 2022, 13: 1045206.
3. Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
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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(1): 1-9.
10. 中華預防醫學會醫院感染控制分會, 中華醫學會感染病學分會, 中國醫院協會醫院感染管理專業委員會, 等. 中國碳青霉烯耐藥革蘭陰性桿菌(CRO)感染預防與控制技術指引. 中華醫院感染學雜志, 2019, 29(13): 2075-2080.
11. 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.
12. Tomczyk S, Zanichelli V, Grayson ML, et al. Control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in healthcare facilities: a systematic review and reanalysis of quasi-experimental studies. Clin Infect Dis, 2019, 68(5): 873-884.
13. T?ngdén T, Giske CG. Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. J Intern Med, 2015, 277(5): 501-512.
14. Dos Santos WM, Aromataris E, Secoli SR, et al. Cost-effectiveness of antimicrobial treatment for inpatients with carbapenem-resistant Klebsiella pneumoniae infection: a systematic review of economic evidence. JBI Database System Rev Implement Rep, 2019, 17(12): 2417-2451.
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16. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials, 1996, 17(1): 1-12.
17. 黃輝萍, 張世陽, 連羨玉, 等. 接觸隔離預防控制耐碳青霉烯類耐藥菌傳播效果分析. 中華醫院感染學雜志, 2017, 27(18): 4098-4101, 4158.
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20. He L, Fu Z, Wang M, et al. Prevention and treatment of carbapenem-resistant organism bacilli from liver transplantation donors-single center experience. Infect Drug Resist, 2022, 15: 47-52.
21. 殷麗軍, 繆瑾, 楊韋菁, 等. 兒童醫院重點部門耐碳青霉烯類革蘭陰性桿菌主動篩查結合集中安置干預效果評價. 中國感染控制雜志, 2021, 20(5): 443-448.
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29. 陳娟, 何華云, 鞠燕, 等. 抗生素管理及手衛生對新生兒耐碳青霉烯類腸桿菌科細菌感染的影響. 臨床兒科雜志, 2014(10): 940-944.
30. 閆巖, 田穎, 耿傳營, 等. 循證研究對預防多發性骨髓瘤患者CRE感染的應用效果. 中華醫院感染學雜志, 2018, 28(23): 3627-3630.
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33. 管紅艷, 劉婧嫻, 陳峰, 等. 兒童重癥監護病房耐碳青霉烯類腸桿菌科細菌主動篩查及臨床資料分析. 中國感染與化療雜志, 2021, 21(4): 444-448.
34. 李寧, 陳小會, 周暉, 等. 血液系統惡性腫瘤與實體腫瘤患者碳青霉烯耐藥腸桿菌科細菌定植分布特點及主動篩查評價. 浙江醫學, 2022, 44(7): 729-732.
35. 黃細蓮, 吳盛海, 施鵬飛, 等. 血液科患者腸道碳青霉烯類耐藥的腸桿菌科細菌主動篩查及其效果評價. 中華血液學雜志, 2020, 41(11): 932-936.
36. 陳應書, 游樹平. 集束化干預措施對重癥醫學科耐碳青霉烯鮑曼不動桿菌感染的防控效果研究. 中文科技期刊數據庫(全文版)醫藥衛生, 2022(7): 181-183.
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West China Medical Journal

Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis

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