耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎预防策略的最佳证据总结
|
摘要
目的检索和分析预防耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)呼吸机相关性肺炎的证据,并对最佳证据进行总结。方法通过计算机检索PubMed、Embase、Cochrane循证医学数据库、BMJ-Clinical Evidence、BMJ-Best Practice、uptodate、JBI循证卫生保健国际合作中心图书馆、加拿大安大略护理学会网站、美国国立指南库、英国国家临床优化研究所、中国知网、维普、万方数据库、中国生物医学数据库等,包括所有指南、证据总结、最佳实践信息册、专家共识、系统评价及原始研究。检索时段为建库至2018年6月。由3名研究者对文献质量进行评价,对符合质量标准的文献进行证据提取。结果最终纳入文献9篇,其中1篇中文文献,8篇英文文献;实验研究1篇,队列研究1篇,系统评价5篇,专家共识1篇,指南1篇。总结的最佳证据如下:15 ml 2%氯己定进行口腔冲洗,2次/d,直至患者出院;每日氯己定擦浴;患者入住ICU时及24 h内采集鼻和咽拭子进行MRSA主动筛查;对于鼻腔有MRSA定植的患者,采用莫匹罗星软膏鼻内涂抹;手卫生依从性高及有规范的感染控制措施的医疗机构,可考虑终止保护性隔离;医院环境与医疗设备的清洁和消毒。结论建议临床医护人员对ICU患者进行MRSA的主动筛查,对早期定植患者进行去定植处理,机械通气早期进行氯己定口腔冲洗,保持环境清洁,预防MRSA呼吸机相关性肺炎的发生。
Objective To retrieve and analyze available evidence on prevention of ventilator-associated pneumonia(VAP) due to methicillin-resistant Staphylococcus aureus(MRSA) and summarize the best available evidence.Methods We searched the PubMed,Embase,Cochrane Library,BMJ-Clinical Evidence,BMJ-Best Practice,uptodate,Joanna Briggs Institute(JBI),Registered Nurses' Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),and complementally searched CNKI,Wanfang Database,VIP Database and CBM published up until June 2018,to collect articles including guidelines,evidence summary(ES),best practice information sheet(BPIS),expert consensus,systematic review(SR) and original research.Three authors independently evaluated quality of literatures and extracted data. Results Nine articles were enrolled,including one Chinese language article and eight English articles;one experimental study,one cohort study,five SRs,one expert consensus,and one guideline. Best evidence included:mouth rinses with 15 ml of 2% Chlorhexidine(CHX) digluconate for twice per day until discharge,bed bath with Chlorhexidine daily;active screening with nasal and pharyngeal swab culture for MRSA when admitted to ICU and within 24 hours,using mupirocin in the nostrils for MRSA colonized patients,protective isolation might be cancelled for hospitals with high levels of compliance with hand hygiene and standardized infection prevention strategy,cleaning and disinfection of hospital environment and medical equipments. Conclusion Health care providers should take strategies such as active screening for MRSA as patients admitted to ICU,decolonization,mouth rinses with CHX in early mechanical ventilation,and cleaning and disinfection of environment and equipments,to prevent MRSA-VAP.
Objective To retrieve and analyze available evidence on prevention of ventilator-associated pneumonia(VAP) due to methicillin-resistant Staphylococcus aureus(MRSA) and summarize the best available evidence.Methods We searched the PubMed,Embase,Cochrane Library,BMJ-Clinical Evidence,BMJ-Best Practice,uptodate,Joanna Briggs Institute(JBI),Registered Nurses' Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),and complementally searched CNKI,Wanfang Database,VIP Database and CBM published up until June 2018,to collect articles including guidelines,evidence summary(ES),best practice information sheet(BPIS),expert consensus,systematic review(SR) and original research.Three authors independently evaluated quality of literatures and extracted data. Results Nine articles were enrolled,including one Chinese language article and eight English articles;one experimental study,one cohort study,five SRs,one expert consensus,and one guideline. Best evidence included:mouth rinses with 15 ml of 2% Chlorhexidine(CHX) digluconate for twice per day until discharge,bed bath with Chlorhexidine daily;active screening with nasal and pharyngeal swab culture for MRSA when admitted to ICU and within 24 hours,using mupirocin in the nostrils for MRSA colonized patients,protective isolation might be cancelled for hospitals with high levels of compliance with hand hygiene and standardized infection prevention strategy,cleaning and disinfection of hospital environment and medical equipments. Conclusion Health care providers should take strategies such as active screening for MRSA as patients admitted to ICU,decolonization,mouth rinses with CHX in early mechanical ventilation,and cleaning and disinfection of environment and equipments,to prevent MRSA-VAP.
引文
[1]李亚军,陶方萍,段缓.预防ICU呼吸机相关性肺炎检查单的设计及应用[J].中华护理杂志,2017,52(3):356-358.
[2]Dureau AF,Duclos G,Antonini F,et al.Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit[J].Eur J Clin Microbiol Infect Dis,2017,36(2):267-272.
[3]鲁梅珊,余昆容,李洪娜,等.密闭式吸痰装置更换频率对呼吸机相关性肺炎影响的Meta分析[J].中华护理杂志,2018,53(9):1122-1126.
[4]Li Y,Cao X,Ge H,et al.Targeted surveillance of nosocomial infection in intensive care units of 176 hospitals in Jiangsu province,China[J].J Hosp Infect,2018,99(1):36-41.
[5]Karakuzu Z,Iscimen R,Akalin H,et al.Prognostic risk factors in ventilator-associated pneumonia[J].Med Sci Monit,2018,24:1321-1328.
[6]Gonzalez RP,Rostas J,Simmons JD,et al.Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant staphylococcus aureus in a trauma population[J].Am J Surg,2013,205(3):255-258.
[7]林嘉玲,姚振江.儿童耐甲氧西林金黄色葡萄球菌鼻定植流行病学研究进展[J].中国公共卫生,2017,33(3):514-516.
[8]Huang R,Mehta S,Weed D,et al.Methicillin-resistant staphylococcus aureus survival on hospital fomites[J].Infect Control Hosp Epidemiol,2006,27(11):1267-1269.
[9]Kalil AC,Metersky ML,Klompas M,et al.Executive summary:management of adults with hospital-acquired and ventilator-associated pneumonia:2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J].Clin Infect Dis,2016,63(5):575-582.
[10]Sen S,Johnston C,Greenhalgh D,et al.Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients[J].JBurn Care Res,2016,37(3):166-171.
[11]Ferreira CR,de Souza DF,Cunha TM,et al.The effectiveness of a bundle in the prevention of ventilator-associated pneumonia[J].Braz J Infect Dis,2016,20(3):267-271.
[12]王晓萍,田丽,李茵.预防呼吸机相关性肺炎集束化干预策略的研究现状[J].中华护理杂志,2015,50(9):1113-1116.
[13]Cao B,Tan TT,Poon E,et al.Consensus statement on the management of methicillin-resistant staphylococcus aureus nosocomial pneumonia in Asia[J].Clin Respir J,2015,9(2):129-142.
[14]陈洋,张文平,马利军.耐甲氧西林金黄色葡萄球菌研究进展[J].中华实用诊断与治疗杂志,2015,29(12):1145-1147.
[15]胡雁.循证护理学[M].北京:人民卫生出版社,2012:76,92.
[16]熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AM-STAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[17]The Joanna Briggs Institute.Criticl appraisal checklist for text and opinion[EB/OL].[2018-09-01].http://www.joannabriggs.org/research/critical-appraisa-l-tools.html.
[18]Brouwers MC,Kho ME,Browman GP,et al.AGREEⅡ:advancing guideline development,reporting and evaluation in health care[J].Prev Med,2010,51(5):421-424.
[19]The Joanna Briggs Institute.Criticl appraisal checklist for cohort studies[EB/OL].[2018-09-03].http://www.joannabriggs.org/research/critical-appraisal-tools.html.
[20]Frost SA,Alogso MC,Metcalfe L,et al.Chlorhexidine bathing and health care-associated infections among adult intensive care patients:a systematic review and meta-analysis[J].Crit Care,2016,20(1):379.
[21]郭佳钰,侯惠如,张瑞芹,等.氯己定擦浴预防ICU患者院内感染的Meta分析[J].解放军医学院学报,2017,38(10):957-963.
[22]Tuon FF,Gavrilko O,Almeida S,et al.Prospective,randomised,controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine[J].J Glob Antimicrob Resist,2017,8:159-163.
[23]Dadashi M,Nasiri MJ,Fallah F,et al.Methicillin-resistant staphylococcus aureus(MRSA)in Iran:a systematic review and meta-analysis[J].J Glob Antimicrob Resist.2018,12(3):96-103.
[24]Parente DM,Cunha CB,Mylonakis E,et al.The clinical utility of methicillin resistant staphylococcus aureus(MRSA)nasal screening to rule out MRSA pneumonia:a diagnostic metaanalysis with antimicrobial stewardship implications[J].Clin Infect Dis,2018,67(1):1-7.
[25]Marra AR,Edmond MB,Schweizer ML,et al.Discontinuing contact precautions for multidrug-resistant organisms:a systematic literature review and meta-analysis[J].Am J Infect Control,2018,46(3):333-340.
[26]Aureden K,Arias K,Burns LA,et al.Guide to the elimination of methicillin-resistant staphylococcus aureus(MRSA)transmission in hospital settings[EB/OL].(2010-03-12)[2018-09-02].http://www.apic.org/Resource_/EliminationGuideForm/631fcd91-8773-4067-9f85-ab2a5b157eab/File/MRSA-elimination-guide-2010.pdf.
[27]Zahar JR,Garrouste-orgeas M,Vesin A,et al.Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events[J].Intensive Care Med,2013,39(12):2153-2160.
[28]王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[2]Dureau AF,Duclos G,Antonini F,et al.Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit[J].Eur J Clin Microbiol Infect Dis,2017,36(2):267-272.
[3]鲁梅珊,余昆容,李洪娜,等.密闭式吸痰装置更换频率对呼吸机相关性肺炎影响的Meta分析[J].中华护理杂志,2018,53(9):1122-1126.
[4]Li Y,Cao X,Ge H,et al.Targeted surveillance of nosocomial infection in intensive care units of 176 hospitals in Jiangsu province,China[J].J Hosp Infect,2018,99(1):36-41.
[5]Karakuzu Z,Iscimen R,Akalin H,et al.Prognostic risk factors in ventilator-associated pneumonia[J].Med Sci Monit,2018,24:1321-1328.
[6]Gonzalez RP,Rostas J,Simmons JD,et al.Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant staphylococcus aureus in a trauma population[J].Am J Surg,2013,205(3):255-258.
[7]林嘉玲,姚振江.儿童耐甲氧西林金黄色葡萄球菌鼻定植流行病学研究进展[J].中国公共卫生,2017,33(3):514-516.
[8]Huang R,Mehta S,Weed D,et al.Methicillin-resistant staphylococcus aureus survival on hospital fomites[J].Infect Control Hosp Epidemiol,2006,27(11):1267-1269.
[9]Kalil AC,Metersky ML,Klompas M,et al.Executive summary:management of adults with hospital-acquired and ventilator-associated pneumonia:2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J].Clin Infect Dis,2016,63(5):575-582.
[10]Sen S,Johnston C,Greenhalgh D,et al.Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients[J].JBurn Care Res,2016,37(3):166-171.
[11]Ferreira CR,de Souza DF,Cunha TM,et al.The effectiveness of a bundle in the prevention of ventilator-associated pneumonia[J].Braz J Infect Dis,2016,20(3):267-271.
[12]王晓萍,田丽,李茵.预防呼吸机相关性肺炎集束化干预策略的研究现状[J].中华护理杂志,2015,50(9):1113-1116.
[13]Cao B,Tan TT,Poon E,et al.Consensus statement on the management of methicillin-resistant staphylococcus aureus nosocomial pneumonia in Asia[J].Clin Respir J,2015,9(2):129-142.
[14]陈洋,张文平,马利军.耐甲氧西林金黄色葡萄球菌研究进展[J].中华实用诊断与治疗杂志,2015,29(12):1145-1147.
[15]胡雁.循证护理学[M].北京:人民卫生出版社,2012:76,92.
[16]熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AM-STAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[17]The Joanna Briggs Institute.Criticl appraisal checklist for text and opinion[EB/OL].[2018-09-01].http://www.joannabriggs.org/research/critical-appraisa-l-tools.html.
[18]Brouwers MC,Kho ME,Browman GP,et al.AGREEⅡ:advancing guideline development,reporting and evaluation in health care[J].Prev Med,2010,51(5):421-424.
[19]The Joanna Briggs Institute.Criticl appraisal checklist for cohort studies[EB/OL].[2018-09-03].http://www.joannabriggs.org/research/critical-appraisal-tools.html.
[20]Frost SA,Alogso MC,Metcalfe L,et al.Chlorhexidine bathing and health care-associated infections among adult intensive care patients:a systematic review and meta-analysis[J].Crit Care,2016,20(1):379.
[21]郭佳钰,侯惠如,张瑞芹,等.氯己定擦浴预防ICU患者院内感染的Meta分析[J].解放军医学院学报,2017,38(10):957-963.
[22]Tuon FF,Gavrilko O,Almeida S,et al.Prospective,randomised,controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine[J].J Glob Antimicrob Resist,2017,8:159-163.
[23]Dadashi M,Nasiri MJ,Fallah F,et al.Methicillin-resistant staphylococcus aureus(MRSA)in Iran:a systematic review and meta-analysis[J].J Glob Antimicrob Resist.2018,12(3):96-103.
[24]Parente DM,Cunha CB,Mylonakis E,et al.The clinical utility of methicillin resistant staphylococcus aureus(MRSA)nasal screening to rule out MRSA pneumonia:a diagnostic metaanalysis with antimicrobial stewardship implications[J].Clin Infect Dis,2018,67(1):1-7.
[25]Marra AR,Edmond MB,Schweizer ML,et al.Discontinuing contact precautions for multidrug-resistant organisms:a systematic literature review and meta-analysis[J].Am J Infect Control,2018,46(3):333-340.
[26]Aureden K,Arias K,Burns LA,et al.Guide to the elimination of methicillin-resistant staphylococcus aureus(MRSA)transmission in hospital settings[EB/OL].(2010-03-12)[2018-09-02].http://www.apic.org/Resource_/EliminationGuideForm/631fcd91-8773-4067-9f85-ab2a5b157eab/File/MRSA-elimination-guide-2010.pdf.
[27]Zahar JR,Garrouste-orgeas M,Vesin A,et al.Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events[J].Intensive Care Med,2013,39(12):2153-2160.
[28]王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.