心外科ICU仅多粘菌素敏感的多重耐药鲍曼不动杆菌预防控制策略（来自希腊的报告）

David

Eur J Cardiothorac Surg. 2008 Mar 12 [Epub ahead of print]
Preventing strategy of multidrug-resistant Acinetobacter baumanii susceptible only to colistin in cardiac surgical intensive care units.
心外科ICU仅多粘菌素敏感的多重耐药鲍曼不动杆菌预防控制策略（来自希腊的报告）
Mastoraki A, Douka E, Kriaras I, Stravopodis G, Saroglou G, Geroulanos S.
Department of Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Avenue, 17674 Athens, Greece.

Objective: The study aimed to determine the incidence and mortality of multidrug-resistant Acinetobacter baumannii in cardiac surgery, to elucidate the effectiveness of colistin treatment and to identify if the additional measures to the recommended procedures were able to control the dissemination of the pathogen. Methods: A prospective observational cohort was conducted among cardiac surgical patients from 1 September 2005 to 31 December 2006. We reviewed the prophylactic measures of the surgical intensive care unit and implemented a two scale multiple program. Scale I included classical infection control measures, while Scale II referred to the geographic isolation of multidrug-resistant Acinetobacter baumannii patients and environmental intense surveillance. Results: Among 151 out of 1935 infected patients 20 were colonized and infected by strains of multidrug-resistant A. baumannii susceptible only to colistin. Seventeen patients presented respiratory tract infection, one patient suffered deep surgical site infection and two patients catheter related infection. Transmission of the pathogen occurred via two patients transferred from two other institutions. They were all treated with colistin. Cure or clinical improvement was observed only in four patients (20%). Scale I measures were implemented for the whole 16-month period while scale II for two separate periods of 3 weeks. Environmental specimens (n>350) proved negative. Conclusions: The increasing prevalence of multidrug-resistant A. baumannii in surgical intensive care unit patients creates demand on strict screening and contact precautions. Following this infection control strategy we were able to achieve intermittent eradication of the pathogen during a 16-month period with continuous function of the intensive care unit. Despite the significant in vitro activity of colistin against multidrug-resistant Acinetobacter baumannii the results were discouraging.

温暖

心外科ICU仅多粘菌素敏感的多重耐药鲍曼不动杆菌预防控制策略。非常想学习，但全是英文，不怕版主笑话，能否提供中文版，以便学习。谢谢！！:/,.nmbn

David

Objective: The study aimed to determine the incidence and mortality of multidrug-resistant Acinetobacter baumannii in cardiac surgery, to elucidate the effectiveness of colistin treatment and to identify if the additional measures to the recommended procedures were able to control the dissemination of the pathogen.(目的：本研究为了弄清多重耐药鲍曼不动杆菌在心外科的发病和致死率情况，目的是阐明多粘菌素治疗的效果和附加在推荐程序之外的措施是否能够控制病原菌的播散。) Methods: A prospective observational cohort was conducted among cardiac surgical patients from 1 September 2005 to 31 December 2006. （方法：回顾性队列观察从2005年9月1日至2006年12月心外科手术病人。）We reviewed the prophylactic measures of the surgical intensive care unit and implemented a two scale multiple program. （我们回顾了ICU的预防措施并且设置了两组对照。）Scale I included classical infection control measures, while Scale II referred to the geographic isolation of multidrug-resistant Acinetobacter baumannii patients and environmental intense surveillance. （一组包括传统的感控措施，而另一组对多重耐药鲍曼感染的病人进行区域隔离和持续环境监测。）Results: Among 151 out of 1935 infected patients 20 were colonized and infected by strains of multidrug-resistant A. baumannii susceptible only to colistin. Seventeen patients presented respiratory tract infection, one patient suffered deep surgical site infection and two patients catheter related infection. （结果：在1935个术后患者中，151人感染鲍曼，其中20人为仅多粘菌素敏感的多重耐药鲍曼不动杆菌。17人有呼吸道感染，1人手术部位深部感染，2人导管相关感染。）Transmission of the pathogen occurred via two patients transferred from two other institutions. （致病菌是通过两个病人从其他2个病区传播进来。）They were all treated with colistin. （他们都接受了多粘菌素治疗。）Cure or clinical improvement was observed only in four patients (20%). （只有4人占20%得到治愈或临床改善。）Scale I measures were implemented for the whole 16-month period while scale II for two separate periods of 3 weeks. （第一组的措施应用了16个月，第二组分两次每次用了3周。）Environmental specimens (n>350) proved negative. （超过250个环境样本为阴性。）Conclusions: The increasing prevalence of multidrug-resistant A. baumannii in surgical intensive care unit patients creates demand on strict screening and contact precautions. （结论：在心外科多重耐药鲍曼不动杆菌的流行需要对病人进行严格筛查和接触防护。）Following this infection control strategy we were able to achieve intermittent eradication of the pathogen during a 16-month period with continuous function of the intensive care unit. （遵循这个感控策略，我们能够在16个月持续运转ICU的同时消除致病菌的扩散。）Despite the significant in vitro activity of colistin against multidrug-resistant Acinetobacter baumannii the results were discouraging.（尽管多粘菌素对鲍曼体外活性有意义，但实际结果令人无法满意。）

怡之秋

在心外科多重耐药鲍曼不动杆菌的流行需要对病人进行严格筛查和接触防护。尽管多粘菌素对鲍曼体外活性有意义，但实际结果令人无法满意。

这段文字总结真是很有现实意义。一定很临床医生多多沟通。。。特别是接触防护太有必要了，刻不容缓！真诚感谢老师的无私奉献。

lunna26

多做一些试验，多拿一些临床证据来说服医生，这样有助于我们工作开展，更有说服力。我们积极响应胡教授的号召，科学的做学问科学的做事情。

太阳沐春花

这个问题对于我们医院亟待解决，但就是不知道从哪里入手？