Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?
Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?
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DOI：
10.3390/jcm9092744
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发表时间：
2020-08-25
影响因子：
3.9
通讯作者：
Cappanera S
中科院分区：
文献类型：
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作者：
Tiri B;Sensi E;Marsiliani V;Cantarini M;Priante G;Vernelli C;Martella LA;Costantini M;Mariottini A;Andreani P;Bruzzone P;Suadoni F;Francucci M;Cirocchi R;Cappanera S
意大利与肺炎克雷伯菌耐药菌感染相关的疾病负担非常高，主要归因于耐碳青霉烯类肺炎克雷伯菌（CR-Kp）。实施感染控制措施和抗菌药物管理计划（ASP）已被证明可以减少由多药耐药（MDR）细菌引起的医疗保健相关感染。自2016年以来，在我们的特尔尼教学医院，ASP已在重症监护室（ICU）环境中实施，采用“每日ICU查房策略”，并特别关注感染控制措施。我们进行了积极的监测，搜索耐碳青霉烯肠杆菌科（CRE）的患者。2020年3月，2019年冠状病毒病（COVID-19）到来，同一个ICU仅为COVID-19患者保留。在我们的回顾性观察性研究中，我们分析了2019年1月至2020年6月期间我院ICU中CRE定植患者的双月发生率和CRE获得的发生率。考虑到COVID-19时代对所有员工的高度重视和感染控制措施的培训，我们本应预期CRE收购明显减少，但这并没有发生。事实上，CRE收购的发生率从2019年的6.7%上升到2020年3月至4月的50%。我们注意到，67%的患者已经改变了姿势与俯卧位是由CRE殖民，而只有37%的患者没有改变姿势是由CRE殖民。我们认为，高强度的护理、需要4-5名医护人员（HCW）的俯卧位、在高风险区域配备个人防护装备（PPE）、与患者的长期接触、以及来自其他科室的32名新HCW的存在和在ICU环境中没有工作经验，导致了CR-Kp在我们ICU的传播，确定CRE获得定殖的增加。
The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.
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