Infection Prevention and Control Strategies According to the Type of Multidrug-Resistant Bacteria and Candida auris in Intensive Care Units: A Pragmatic Resume including Pathogens R0 and a Cost-Effectiveness Analysis

被引:2
|
作者
Fanelli, Chiara [1 ]
Pistidda, Laura [1 ]
Terragni, Pierpaolo [1 ,2 ]
Pasero, Daniela [1 ,3 ]
机构
[1] Univ Sassari, Dept Med Surg & Pharm, I-07100 Sassari, Italy
[2] Univ Hosp Sassari, Intens Care Unit, I-07100 Sassari, Italy
[3] Civil Hosp Alghero, Intens Care Unit, I-07041 Alghero, Italy
来源
ANTIBIOTICS-BASEL | 2024年 / 13卷 / 08期
关键词
infection prevention and control; hospital-acquired infections; outbreak; multidrug-resistant bacteria; Acinetobacter baumanii; Candida auris; VRE; KPC; basic reproduction number; decolonization; CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE; STAPHYLOCOCCUS-AUREUS COLONIZATION; BASIC REPRODUCTION NUMBER; LACTAMASE-PRODUCING ENTEROBACTERIACEAE; ACINETOBACTER-BAUMANNII INFECTIONS; CRITICALLY-ILL PATIENTS; KLEBSIELLA-PNEUMONIAE; RISK-FACTORS; PSEUDOMONAS-AERUGINOSA; ECONOMIC-EVALUATION;
D O I
10.3390/antibiotics13080789
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Multidrug-resistant organism (MDRO) outbreaks have been steadily increasing in intensive care units (ICUs). Still, healthcare institutions and workers (HCWs) have not reached unanimity on how and when to implement infection prevention and control (IPC) strategies. We aimed to provide a pragmatic physician practice-oriented resume of strategies towards different MDRO outbreaks in ICUs. We performed a narrative review on IPC in ICUs, investigating patient-to-staff ratios; education, isolation, decolonization, screening, and hygiene practices; outbreak reporting; cost-effectiveness; reproduction numbers (R0); and future perspectives. The most effective IPC strategy remains unknown. Most studies focus on a specific pathogen or disease, making the clinician lose sight of the big picture. IPC strategies have proven their cost-effectiveness regardless of typology, country, and pathogen. A standardized, universal, pragmatic protocol for HCW education should be elaborated. Likewise, the elaboration of a rapid outbreak recognition tool (i.e., an easy-to-use mathematical model) would improve early diagnosis and prevent spreading. Further studies are needed to express views in favor or against MDRO decolonization. New promising strategies are emerging and need to be tested in the field. The lack of IPC strategy application has made and still makes ICUs major MDRO reservoirs in the community. In a not-too-distant future, genetic engineering and phage therapies could represent a plot twist in MDRO IPC strategies.
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页数:31
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