在ICU接受连续脏置换治疗的患者中,选择性消化道去污染和鼻腔感染之间的关系:一个多中心研究
Juan Luis Vicente Arranz1, Catalina Sánchez-Ramírez1, Pedro Saavedra2
1Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, University of Las Palmas de Gran Canaria, Barranco de la Ballena s/n, E-35010 Las Palmas de Gran Canaria, Spain.
选择性消化清除 (SDD) 在接受脏替代疗法 (RRT) 的患者中显著减少了重症监护室 (ICU) 获得的感染和多药耐药细菌 (MDRB). 这一策略被推用于重症监护机构的感染控制.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 鼻腔感染构成了全球医疗保健的重大挑战,特别是在ICU,在2023年西班牙的患病率为21.1%.
- 侵入性手术,包括置换疗法 (RRT),是这些感染的主要危险因素.
- 西班牙的ZERO全国战略建议选择性消化道消毒 (SDD) 作为一种高效的感染预防方法.
研究的目的:
- 为了比较ICU获得感染和多药耐药细菌 (MDRB) 的发病率在接受RRT的患者中,有或没有SDD.
- 评估SDD作为重症患者感染控制策略的有效性.
主要方法:
- 一项多中心,前性,观察性研究在西班牙两家三级医院进行.
- 分析了140名接受RRT的患者,比较了暴露于SDD和未暴露患者之间的结果.
- 进行了监测培养和风险因素评估,以确定感染率和MDRB发病率.
主要成果:
- SDD显著减少了与RRT相关的医院感染 (OR:0.10) 和MDRB发病率 (IDR:0.156).
- 机械通风 (OR:7.91) 和外周血管疾病 (OR:3.17) 与感染风险增加有关.
- 在所有关键发现中都观察到统计学意义 (95%的CI提供).
结论:
- 这项研究支持在ICU治疗功能衰竭的持续RRT (CRRT) 患者中使用SDD.
- SDD是控制ICU获得感染和减少MDRB的有效工具.
- 实施SDD可以改善重症监护机构患者的治疗结果.
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