A Regional Informatics Platform for Coordinated Antibiotic-Resistant Infection Tracking, Alerting, and Prevention
A Regional Informatics Platform for Coordinated Antibiotic-Resistant Infection Tracking, Alerting, and Prevention
复制标题
DOI：
10.1093/cid/cit229
复制
发表时间：
2013-07-15
影响因子：
11.8
通讯作者：
Overhage, J. Marc
中科院分区：
文献类型：
--
作者：
Kho, Abel N.;Doebbeling, Bradley N.;Overhage, J. Marc
背景我们开发并评估了与区域抗菌素耐药性（AMR）相关的患者登记和电子入院通知系统对区域AMR感染率随时间推移的影响。我们对2003年至2010年期间由5个医疗保健系统中的任何一个确定为至少1次感染或定植耐甲氧西林金黄色葡萄球菌（MRSA）和/或万古霉素耐药肠球菌（VRE）的所有患者进行了观察性队列研究。这5个医疗保健系统包括17家医院和相关诊所在印第安纳波利斯，印第安纳州，地区。我们开发并标准化了MRSA和VRE患者的注册表，并创建了感染预防专家（IP）用于维护列表的Web表单。从2007年6月到2010年6月，每当有既往感染或定植MRSA或VRE的患者登记入住研究医院时，我们都会向IP发送电子邮件警报。在3年的时间里，我们向17家医院的24个IP发送了12 748封关于6270名独特患者的电子邮件警报。五分之一（22%-23%）的入院警报是基于来自与入院医院不同的医疗保健系统的数据;少数医院占设施和系统之间交叉的大部分。区域患者登记研究确定了一个重要的患者队列，该队列具有来自不同医疗机构的相关既往耐药感染数据。区域登记系统可以识别单一机构数据中不明显的趋势和机构间流动。重要的是，电子警报可以通知需要及早隔离，并采取其他措施防止传播。
Background. We developed and assessed the impact of a patient registry and electronic admission notification system relating to regional antimicrobial resistance (AMR) on regional AMR infection rates over time. We conducted an observational cohort study of all patients identified as infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) on at least 1 occasion by any of 5 healthcare systems between 2003 and 2010. The 5 healthcare systems included 17 hospitals and associated clinics in the Indianapolis, Indiana, region.Methods. We developed and standardized a registry of MRSA and VRE patients and created Web forms that infection preventionists (IPs) used to maintain the lists. We sent e-mail alerts to IPs whenever a patient previously infected or colonized with MRSA or VRE registered for admission to a study hospital from June 2007 through June 2010.Results. Over a 3-year period, we delivered 12 748 e-mail alerts on 6270 unique patients to 24 IPs covering 17 hospitals. One in 5 (22%-23%) of all admission alerts was based on data from a healthcare system that was different from the admitting hospital; a few hospitals accounted for most of this crossover among facilities and systems.Conclusions. Regional patient registries identify an important patient cohort with relevant prior antibiotic-resistant infection data from different healthcare institutions. Regional registries can identify trends and interinstitutional movement not otherwise apparent from single institution data. Importantly, electronic alerts can notify of the need to isolate early and to institute other measures to prevent transmission.