A managed multidisciplinary programme on multi-resistant Klebsiella pneumoniae in a Danish university hospital
A managed multidisciplinary programme on multi-resistant Klebsiella pneumoniae in a Danish university hospital
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DOI：
10.1136/bmjqs-2012-001791
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发表时间：
2013-11-01
影响因子：
5.4
通讯作者：
Knudsen, Jenny Dahl
中科院分区：
文献类型：
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作者：
Andersen, Stig Ejdrup;Knudsen, Jenny Dahl
背景 细菌产生的超广谱内酰胺酶 (ESBL) 对常用的抗菌药物具有耐药性。 2008 年，常规监测发现医院爆发了产 ESBL 肺炎克雷伯菌 (ESBL-KP) 的克隆疫情。 方法 在一家拥有 510 个床位的丹麦大学医院，受科特变革八步的启发，设计了一个多学科变革项目。除了修订抗菌指南和限制选定的抗菌药物外，复杂的、有管理的、多方面的干预措施还包括培训和教育、加强隔离预防措施以及一系列改善感染控制措施和标准化整个医院程序的行动。采用前瞻性中断时间序列设计来分析 2008 年 1 月至 2011 年 12 月期间在医院层面收集的数据。 结果 尽管抗菌药物总体消耗量未受影响，但干预措施导致头孢呋辛的使用立即持续减少，厄他培南、哌拉西林/他唑巴坦和β-内酰胺酶敏感青霉素的使用增加。此外，观察到干预后诊断样本中 ESBL-KP 的比率和 ESBL-KP 感染的发生率有所下降。该干预措施还可能减少了隔离预防措施的需要，并可能缩短了每次隔离期。 结论 结果表明，通过应用管理的、多方面的干预措施，不需要持续的抗生素管理，可以实现抗菌药物消耗的立即和持续的变化以及 ESBL-KP 率的下降。
Background Bacteria-producing extended spectrum -lactamase (ESBL) enzymes are resistant to commonly used antimicrobials. In 2008, routine monitoring revealed a clonal hospital outbreak of ESBL-producing Klebsiella pneumoniae (ESBL-KP).Methods At a 510-bed Danish university hospital, a multidisciplinary change project inspired by Kotter's Eight Steps of Change was designed. In addition to revision of antimicrobial guidelines and restriction of selected antimicrobials, the complex, managed, multi-faceted intervention comprised training and education, enhanced isolation precautions, and a series of actions to improve the infection control measures and standardise procedures across the hospital. A prospective interrupted time series design was used to analyse data collected at hospital level from January 2008 through December 2011.Results Though overall antimicrobial consumption remained unaffected, the intervention led to intended, immediate and sustained reduction in the use of cefuroxime, and an increase in the use of ertapenem, piperacillin/tazobactam and -lactamase sensitive penicillin. Moreover, a postintervention reduction in the rate of ESBL-KP in diagnostic samples and in the incidence of ESBL-KP infections was observed. The intervention may also have reduced the need for isolation precautions and may have shortened each isolation period.Conclusions The results indicate that an immediate and sustained change in the antimicrobial consumption and a decreasing rate of ESBL-KP are achievable through the application of a managed, multi-faceted intervention that does not require ongoing antibiotic stewardship.