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首页> 外文期刊>Critical care medicine >Short-term decline in all-cause acquired infections with the routine use of a decontamination regimen combining topical polymyxin, tobramycin, and amphotericin B with mupirocin and chlorhexidine in the ICU: A single-center experience
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Short-term decline in all-cause acquired infections with the routine use of a decontamination regimen combining topical polymyxin, tobramycin, and amphotericin B with mupirocin and chlorhexidine in the ICU: A single-center experience

机译：所有导致的短期下降都有所获得的感染与常规使用局部多霉素，染发蛋白和两性霉素与ICU中的Mupirocin和氯己定结合的拆纳米霉素和两性霉素：单中心经验

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摘要

Objectives: In a multicenter, placebo-controlled, randomized, double-blind trial, we showed that acquired infections in intubated patients were reduced by the combination of topical polymyxin plus tobramycin and nasal mupirocin plus chlorhexidine body wash. Because intubated patients are particularly at risk for acquired infections, we reassessed the impact of this protocol as a routine procedure to control acquired infections in the ICU. Design: Nonrandomized study comparing acquired infections in ICU patients during two 1-year periods: the last year before (group A, n = 925) and the first year after the implementation of the protocol (group B, n = 1,022). Acquired infections were prospectively recorded. Setting: Polyvalent medical ICU at a university-affiliated hospital. Patients: All patients admitted to the ICU. Interventions: Administration of polymyxin/tobramycin/amphotericin B in the oropharynx and the gastric tube plus a mupirocin/chlorhexidine regimen in intubated patients and standard care in the other patients. Measurements and Main Results: The comparison of acquired infection rates between groups was adjusted for differences at baseline. Infection rates were lower in group B compared with group A (5.3% vs 11.0%; p < 0.001), as were the incidence rates of total acquired infections (9.4 vs 23.6 per 1,000 patient-days; p < 0.001), intubation-related pneumonia (5.1 vs 17.1 per 1,000 ventilator-days; p < 0.001), and catheter-related bloodstream infections (1.0 vs 3.5 per 1,000 catheter-days; p = 0.03). There were fewer acquired infections caused by ceftazidime-resistant Enterobacteriaceae (0.8‰ vs 3.6‰; p < 0.001), ciprofloxacin-resistant Enterobacteriaceae (0.8‰ vs 2.5‰; p = 0.02), ciprofloxacin- resistant Pseudomonas aeruginosa (0.5‰ vs 1.6‰; p = 0.05), and colistin-resistant Gram-negative bacilli (0.7‰ vs 1.9‰; p = 0.04). Fewer patients got acquired infections due to multidrug-resistant aerobic Gram-negative bacilli (p = 0.008). Conclusions: In intubated patients, the use of topical polymyxin/tobramycin/amphotericin B plus mupirocin/chlorhexidine was associated with the reduction of all-cause ICU-acquired infections. Long-term emergence of multidrug-resistant organisms deserves further investigation.
机译：目的：在多中心，安慰剂对照，随机的双盲试验中，我们表明，通过局部多粘素加入腮腺素和鼻Mupirocin加氯己定氯己定氯己定氯己定氯己定含量的药物患者的收购感染减少。由于插管的患者特别有受欢迎的感染风险，因此我们重新评估了该议定书的影响作为控制ICU中获得的感染的常规程序。设计：非萌化研究比较ICU患者在两个1年期间的收购感染：去年之前（A，N = 925次）和执行议定书的第一年（B组，N = 1,022组）。预期记录了获得的感染。环境：大学附属医院的PolyValent医疗ICU。患者：所有患者均承认ICU。干预：在口腔内施用聚吡嗪/毒素/两性霉素B，胃管加上插管患者中的Mupirocin / Chlorhepidine方案和其他患者的标准护理。测量和主要结果：调整基线之间获得的群体的感染率的比较进行基线差异。 B组的感染率较低，与A组（5.3％vs11.0％; p <0.001），也是总收养的感染的发生率（9.4与每1,000例患者天; p <0.001），与插管相关的肺炎（5.1 vs17.1每1,000个呼吸机 - 天; p <0.001）和导管相关的血流感染（每1,000 vs 3.5，每1,000导管天; p = 0.03）。耐药肠杆菌痤疮会导致的收购感染较少（0.8‰vs 3.6‰; p <0.001），铁氟氯酰均抗肠杆菌菌（0.8‰vs 2.5‰; p = 0.02），环丙沙星抗性假单胞菌铜绿假单胞菌（0.5‰vs 1.6‰ ; P = 0.05），耐菌腐蚀革兰阴性杆菌（0.7≥1.9‰; p = 0.04）。由于多药抗性的有氧革兰阴性Bacilli（p = 0.008），较少的患者获得感染。结论：在插管患者中，使用局部多粘蛋白/炸素/两性霉素B Plus Mupirocin / Chlorhepidine的使用与所有导致的ICU获取的感染的减少有关。多药物的长期出现值得进一步调查。

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  • 来源
    《Critical care medicine》 |2014年第5期|共10页
  • 作者

    CamusC.; SalomonS.; BouchignyC.; GacouinA.; LavouéS.; DonnioP.-Y.; JavaudinL.; ChapplainJ.-M.; UhelF.; LeTulzoY.; BellissantE.;

  • 作者单位

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Centre d'Investigation Clinique CIC-P INSERM 0203 H?pital de Pontchaillou Université de Rennes 1;

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Laboratoire de Bactériologie Virologie et Hygiène Hospitalière Université de Rennes 1 Rennes;

    P?le Pharmacie Hospitalière H?pital de Pontchaillou CHU de Rennes Rennes France;

    Laboratoire de Bactériologie Virologie et Hygiène Hospitalière Université de Rennes 1 Rennes;

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Service de Maladies Infectieuses et Réanimation Médicale H?pital de Pontchaillou Université de;

    Centre d'Investigation Clinique CIC-P INSERM 0203 H?pital de Pontchaillou Université de Rennes 1;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 护理学;
  • 关键词

    chlorhexidine; intensive care unit-acquired infections; intubated patients; mupirocin; selective digestive decontamination; ventilator-associated pneumonia;

    机译：氯己定;密集护理单位获得的感染;插管患者;含钙;选择性消化去污;呼吸机相关的肺炎;

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