本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.2759

摘要内容如下：

重要性

多重耐药菌（MDRO）引起的感染与发病率、死亡率、住院时间和医疗费用的增加有关。区域干预措施可能有利于减轻MDRO和相关感染。

目的

评估非殖民化协作的实施是否与降低区域MDRO流行率、偶发临床培养、感染相关住院、费用和死亡相关。

设计、设置和参与者

这项质量改进研究于2017年7月1日至2019年7月31日在加利福尼亚州奥兰治县的35家医疗保健机构进行。

曝光

洗必泰沐浴和鼻腔碘伏消毒用于长期护理居民和住院患者的接触预防措施（CP）。

主要成果和措施

参与机构中MDRO点的基线和干预结束流行率；参与和非参与机构中的偶发MDRO（非筛查）临床培养；以及参与和未参与疗养院（NHS）的居民中与感染相关的住院治疗和相关费用和死亡。

结果

35家机构（16家医院，16家NHS，3家长期急症护理医院[LTACH]）采用了干预措施。与基线期相比，在参与机构中，平均（SD）MDRO患病率在NHS中从63.9%（12.2%）降至49.9%（11.3%），在LTACH中从80.0%（7.2%）降至53.3%（13.3%）（NHS和LTACH的比值比[OR]为0.48；95%CI为0.40~0.57），OR值为0.75（64.1%，8.5%），OR值为0.75（55.4%，13.8%）。95%CI，0.60-0.93）。当在NHS中与基线比较去殖民化时，在参与的NHS中，平均（SD）每月事件MDRO临床培养从2.7（1.9）变化到1.7（1.1），在未参与的NHS中，从1.7（1.4）变化到1.5（1.1）（组×时期交互作用减少，30.4%；95%CI，16.4%-42.1%），参与医院从25.5（18.6）降至25.0（15.9），未参与医院从12.5（10.1）降至14.3（10.2）（组×时期交互作用减少，12.9%；95%CI，3.3%-21.5%），在LTACH中从14.8（8.6）到8.2（6.1）（所有参与的设施；减少22.5%；95%可信区间，4.4%-37.1%）。对于NHS，每1000个住院日的感染相关住院率在参与的NHS中从基线期间的2.31变化到干预期间的1.94，在未参与的NHS中从1.90变化到2.03（组×期间交互作用减少，26.7%；95%可信区间，19.0%-34.5%）。每1000个住院日的相关住院费用在参与的NHS中从$64651变化到$55149，在未参与的NHS中从$55151变化到$59327（组×期间交互减少，26.8%；95%可信区间，26.7%-26.9%）。在参与的NHS中，每1000个住院日的相关住院死亡从0.29变化到0.25，在未参与的NHS中，从0.23变化到0.24（组×期间交互减少，23.7%；95%可信区间，4.5%-43.0%）。

结论和相关性

涉及长期护理机构的普遍去殖民化和CP住院患者的目标去殖民化的区域合作与较低的MDRO携带、感染、住院、费用和死亡相关。

英文原文如下：

Abstracts

Importance  Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections.

Objective  To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths.

Design, Setting, and Participants  This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California.

Exposures  Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP).

Main Outcomes and Measures  Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs).

Results  Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%).

Conclusions and Relevance  A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.

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