Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.
复制标题
用于向感染预防人员通报多重耐药革兰氏阴性菌患者的新生区域系统：实施和初步结果。
DOI：
10.1086/677833
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发表时间：
2014
影响因子：
4.5
通讯作者：
Kho,AbelN
中科院分区：
文献类型：
--
作者：
Rosenman,MarcB;Szucs,KingaA;Finnell,SMariaE;Khokhar,Shahid;Egg,James;Lemmon,Larry;Shepherd,DavidC;Friedlin,Jeff;Li,Xiaochun;Kho,AbelN
目的建立并开始评估一个区域性自动化系统，当有革兰氏阴性棒多药耐药菌（GNRMDRO）病史的患者被送进急诊科（ED）或住院时，该系统可通知感染预防医师（IPs）。设计：观察性、回顾性研究。27家医院，大部分在印第安纳波利斯市区，在一个健康信息交换（HIE）。在新系统测试期间：2013年10月1日至2013年12月31日期间进行微生物培养的80,180例患者；573人有GNRMDRO。方法/干预获取来自HIE的健康级别7 （HL7）数据馈送，进行校正、增强并用于决策支持（向ip发送安全电子邮件通知）。回顾性分析患者的微生物学数据（2013年10月1日至2013年12月31日）和随后的医疗就诊（至2014年2月6日）。结果573例患者（中位年龄66岁，68%为女性）存在广谱产β-内酰胺酶肠杆菌科（78%）、耐碳青霉烯类肠杆菌科（7%）、铜绿假单胞菌（9%）、鲍曼不动杆菌（3%）或其他GNR（3%）。体源为尿液（68%）、痰液/气管/支气管肺泡灌洗液（13%）、伤口/皮肤（6%）、血液（6%）或其他/不明（7%）。在2013年10月1日至2014年2月6日期间，573名患者中有252名（44%）在接受GNRMDRO培养后急诊或住院，47名（252名中的19%）在不同的机构接受培养。在实际警报的前7周（2014年1月29日至2014年3月19日），产生了67例患者的警报（67例患者中有19例来自其他地方的培养）。结论建立基于微生物学的区域预警系统具有一定的挑战性，但最终是可行的。甚至在几个月内，我们就观察到机构之间存在大量交叉。该系统如果有助于及时隔离，可能有助于减少gnrmro的传播。
ObjectiveTo build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.DesignObservational, retrospective study.SettingTwenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).PatientsDuring testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO.Methods/InterventionA Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).ResultsThe 573 patients (median age, 66 years; 68% women) had extended-spectrum β-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn).ConclusionsIt proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.