The transmission of nosocomial pathogens in an intensive care unit: a space-time clustering and structural equation modelling approach
The transmission of nosocomial pathogens in an intensive care unit: a space-time clustering and structural equation modelling approach
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DOI：
10.1017/s095026880999094x
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发表时间：
2010-06-01
影响因子：
4.2
通讯作者：
O'Donnell, A. G.
中科院分区：
文献类型：
--
作者：
Rushton, S. P.;Shirley, M. D. F.;O'Donnell, A. G.
我们调查了重症监护病房的院内病原体病例和危险因素的发生率，以确定病例数是否取决于患者的位置和病房的定植/感染史。开发了一种聚类方法来调查五种微生物[耐甲氧西林金黄色葡萄球菌（M RSA），不动杆菌属，克雷伯氏菌属，念珠菌属，和铜绿假单胞菌]使用医院微生物监测数据和病房病床使用记录。MRSA、念珠菌和假单胞菌定植/感染病例在床内和时间内聚集，而克雷伯菌和不动杆菌病例则不聚集。我们使用结构方程模型来分析相互作用的危险因素和潜在的传播途径在病房。以前护士接触殖民/感染的病人，介导的病床移动的数量，是所有情况下，除了假单胞菌的重要预测因素。一般健康状况和侵入性手术是念珠菌和克雷伯菌病例的重要预测因素。我们认为，隔离和卧床运动作为一种策略来管理MRSA感染可能会影响其他机会致病菌的病例发生率。
We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (M RSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogens.