Targeted versus Universal Decolonization to Prevent ICU Infection
Targeted versus Universal Decolonization to Prevent ICU Infection
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DOI：
10.1056/nejmoa1207290
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发表时间：
2013-06-13
影响因子：
158.5
通讯作者：
Platt, Richard
中科院分区：
文献类型：
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作者：
Huang, Susan S.;Septimus, Edward;Platt, Richard
目标去殖民化和普遍去殖民化的患者在重症监护病房（ICU）的候选策略，以防止医疗保健相关的感染，特别是耐甲氧西林金黄色葡萄球菌（MRSA）引起的。医院被随机分配到三种策略中的一种，给定医院的所有成人ICU都被分配到相同的策略。第1组实施MRSA筛查和分离;第2组，有针对性的去殖民化（即，MRSA携带者的筛选、分离和去殖民化）;和第3组，普遍去殖民化（即，无筛选，所有患者的非殖民化）。使用比例风险模型评估研究组之间感染减少的差异，并根据医院进行聚类。CITTSA共有43家医院（包括74个ICU和74，256名患者）接受随机分组。在干预期与基线期，筛选和分离MRSA临床分离株的模型风险比为0.92（粗速率，3.2 vs. 3.4分离株/1000天），0.75用于靶向去殖民化（3.2 vs. 4.3分离株/1000天）和0.63（普遍去殖民化）（2.1 vs. 3.4分离株/1000天）（P = 0.01，所有组的检验结果相同）。在干预期与基线期，三组中任何病原体血流感染的风险比分别为0.99（粗比率，每1000天4.1对4.2例感染）、0.78（每1000天3.7对4.8例感染）和0.56（每1000天3.6对6.1例感染）（P
BACKGROUNDBoth targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA).METHODSWe conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital.RESULTSA total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P = 0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P