集束化干预措施对综合ICU耐碳青霉烯类肺炎克雷伯菌致呼吸机相关性肺炎防控效果评价

Effect of a bundle of interventions on ventilator-associated pneumonia induced by Carbapenems-resistant Klebsiella pneumonia in intensive care unit

目的探讨集束化干预措施对ICU耐碳青霉烯类肺炎克雷伯菌(CRKP)致呼吸机相关性肺炎(VAP)防控效果评价。方法收集2013-2017年综合ICU呼吸机相关肺炎患者信息,分析其在干预前(2013-2014年)、干预中(2015-2016年)和巩固期(2017年)各阶段监测指标。结果各阶段VAP感染率呈下降趋势。各阶段呼吸机使用率呈升高趋势,巩固期使用率均大于干预前和干预中,差异均有统计学意义;各阶段耐碳青霉烯类肺炎克雷伯菌导致的呼吸机相关性肺炎(CRKP-VAP)占比呈下降趋势; 3个阶段CRKP检出率及肺炎克雷伯菌碳青霉烯类药物耐药率均呈下降趋势,其中干预中及巩固期2种指标均低于干预前。结论集束化干预措施对于预防CRKP所致呼吸性相关肺炎具有较好的效果。

Objective To investigate the application effect of a bundle of interventions on Ventilator-Associated Pneumonia( VAP) induced by Carbapenems-resistant Klebsiella pneumonia( CRKP) in Intensive Care Unit. Methods Retrieving the information of VAP in the information system from 2013 to 2017 was carried out to analyze the surveillance index before intervention( 2013-2014),during intervention( 2015-2016) and after intervention( 2017). Results There were decreasing trends in incidences of VAP per 1 000 ventilator days in all the three periods. There were increasing trends in usage rate of ventilator in all the three periods,and the increasing trends was statistically meaningful. The indexes after intervention were higher than those before intervention and during intervention. There were decreasing trends in the ratio of the amount of CRKP-VAP to the total amount of VAP. There were decreasing trends in isolation rate of CRKP and resistant rate of Carbapenems,and the two indexes after intervention and during intervention were both lower than those before intervention.Conclusion bundle interventions are helpful for the prevention of Ventilator-Associated Pneumonia induced by Carbapenems-resistant Klebsiella pneumonia.