Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis_West China Medical Journal

Authors：

GUO Linwen ^1,2 , HUANG Wenzhi ^1,2 , ZENG Ni ³ ,  QIAO Fu ^1,2

1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Infection Control, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 561113, P. R. China;

Corresponding author：

QIAO Fu, Email: qiaofu2005@scu.edu.cn

Keywords：

Carbapenem-resistant organism; prevention; control; meta-analysis

DOI：

10.7507/1002-0179.202402163

Video：

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Objective To evaluate the efficiency of prevention and control strategies of carbapenem-resistant organism (CRO) in medical institutions in China using meta-analysis method. Methods PubMed, Embase, Medline (Ovid), Web of Science, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Database were systematically searched for studies on CRO prevention and control in Chinese medical institutions from the establishment of databases to 2023 for meta-analysis. Results A total of 21 studies were included, consisting of 3 randomized controlled studies and 18 non-randomized controlled studies. The meta-analysis results showed that compared with standard prevention and control measures, strengthened intervention measures (including active screening, information-based transparent supervision mode, comprehensive intervention, and bundled prevention and control strategies) could effectively reduce the CRO infection rate [relative risk (RR)=0.40, 95% confidence interval (CI) (0.25, 0.65), P<0.05]. Proactive screening could effectively reduce the CRO infection rate [RR=0.52, 95%CI (0.30, 0.91), P<0.05] and carbapenem-resistant Enterobacteriaceae (CRE) infection rate [RR=0.47, 95%CI (0.24, 0.93), P<0.05]. Information-based transparent supervision could reduce the CRE infection rate by improving compliance with standard prevention and control measures [RR=0.42, 95%CI (0.28, 0.62), P<0.05]. Conclusions Compared with standard prevention and control measures, strengthened intervention measures can effectively reduce the risk of in-hospital transmission and infection of CRO. In clinical practice, bundled comprehensive intervention can be combined with information-based transparent supervision, and if necessary, proactive screening of CRO in high-risk populations should be carried out.

Citation： GUO Linwen, HUANG Wenzhi, ZENG Ni, QIAO Fu. Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis. West China Medical Journal, 2024, 39(3): 392-398. doi: 10.7507/1002-0179.202402163 Copy

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2.	Jiang Y, Ding Y, Wei Y, et al. Carbapenem-resistant Acinetobacter baumannii: a challenge in the intensive care unit. Front Microbiol, 2022, 13: 1045206.
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5.	Huang W, Qiao F, Zhang Y, et al. In-hospital medical costs of infections caused by carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis, 2018, 67(Suppl 2): S225-S230.
6.	胡付品, 郭燕, 朱德妹, 等. 2021年CHINET中国细菌耐药监测. 中国感染与化疗杂志, 2022, 22(5): 521-530.
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11.	Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
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15.	Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
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19.	Zhou S, Mi S, Rao X, et al. Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units. Sci Rep, 2023, 13(1): 9527.
20.	He L, Fu Z, Wang M, et al. Prevention and treatment of carbapenem-resistant organism bacilli from liver transplantation donors-single center experience. Infect Drug Resist, 2022, 15: 47-52.
21.	殷丽军, 缪瑾, 杨韦菁, 等. 儿童医院重点部门耐碳青霉烯类革兰阴性杆菌主动筛查结合集中安置干预效果评价. 中国感染控制杂志, 2021, 20(5): 443-448.
22.	万玲, 吴晓琴, 刘晴, 等. 透明监管模式防控耐碳青霉烯肠杆菌科细菌医院感染的效果研究. 中华医院感染学杂志, 2019, 29(20): 3170-3174.
23.	李琳, 吴晓琴, 徐莉, 等. 信息化透明监管干预模式对耐碳青霉烯肺炎克雷伯菌医院感染的防控效果. 护理实践与研究, 2023, 20(3): 383-387.
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27.	Dai Y, Meng T, Wang X, et al. Validation and extrapolation of a multimodal infection prevention and control intervention on carbapenem-resistant Klebsiella pneumoniae in an epidemic region: a historical control quasi-experimental study. Front Med (Lausanne), 2021, 8: 692813.
28.	王广芬, 王福斌, 袁妍妩, 等. 多模式策略对重症监护病房耐碳青霉烯类肠杆菌干预效果评价. 中国消毒学杂志, 2018, 35(12): 909-911.
29.	陈娟, 何华云, 鞠燕, 等. 抗生素管理及手卫生对新生儿耐碳青霉烯类肠杆菌科细菌感染的影响. 临床儿科杂志, 2014(10): 940-944.
30.	闫岩, 田颖, 耿传营, 等. 循证研究对预防多发性骨髓瘤患者CRE感染的应用效果. 中华医院感染学杂志, 2018, 28(23): 3627-3630.
31.	陈美恋, 王守军, 匡季秋, 等. 重症监护病区CRE主动筛查及其效果评价. 中华医院感染学杂志, 2017, 27(18): 4123-4126.
32.	郭辅政, 朱凤雪, 李纾, 等. 主动筛查对重症监护病房内耐碳青霉烯类肠杆菌感染率的影响. 中国医药, 2018, 13(2): 270-273.
33.	管红艳, 刘婧娴, 陈峰, 等. 儿童重症监护病房耐碳青霉烯类肠杆菌科细菌主动筛查及临床资料分析. 中国感染与化疗杂志, 2021, 21(4): 444-448.
34.	李宁, 陈小会, 周晖, 等. 血液系统恶性肿瘤与实体肿瘤患者碳青霉烯耐药肠杆菌科细菌定植分布特点及主动筛查评价. 浙江医学, 2022, 44(7): 729-732.
35.	黄细莲, 吴盛海, 施鹏飞, 等. 血液科患者肠道碳青霉烯类耐药的肠杆菌科细菌主动筛查及其效果评价. 中华血液学杂志, 2020, 41(11): 932-936.
36.	陈应书, 游树平. 集束化干预措施对重症医学科耐碳青霉烯鲍曼不动杆菌感染的防控效果研究. 中文科技期刊数据库(全文版)医药卫生, 2022(7): 181-183.
37.	张海娇, 杨春艳, 张诤, 等. 基于依从性监测的加强干预对鲍曼不动杆菌感染的防控效果. 中国感染控制杂志, 2022, 21(1): 49-54.
38.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
39.	Morgan DJ, Rogawski E, Thom KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med, 2012, 40(4): 1045-1051.
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41.	Belley A, Harris R, Beveridge T, et al. Ultrastructural effects of oritavancin on methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Antimicrob Agents Chemother, 2009, 53(2): 800-804.
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43.	Martin M, Zingg W, Hansen S, et al. Public reporting of healthcare-associated infection data in Europe. What are the views of infection prevention opinion leaders?. J Hosp Infect, 2013, 83(2): 94-98.
44.	梁艳芳, 赖晓全, 谭莉. 透明监管在医院感染管理中的应用研究. 中华医院感染学杂志, 2020, 30(1): 135-140.
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1. Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis, 2018, 18(3): 318-327.
2. Jiang Y, Ding Y, Wei Y, et al. Carbapenem-resistant Acinetobacter baumannii: a challenge in the intensive care unit. Front Microbiol, 2022, 13: 1045206.
3. Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
4. Morii D, Tomono K, Imanaka Y. Economic impact of antimicrobial-resistant bacteria outbreaks on Japanese hospitals. Am J Infect Control, 2020, 48(10): 1195-1199.
5. Huang W, Qiao F, Zhang Y, et al. In-hospital medical costs of infections caused by carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis, 2018, 67(Suppl 2): S225-S230.
6. 胡付品, 郭燕, 朱德妹, 等. 2021年CHINET中国细菌耐药监测. 中国感染与化疗杂志, 2022, 22(5): 521-530.
7. 中华人民共和国卫生部. 多重耐药菌医院感染预防与控制技术指南(试行). 中国危重病急救医学, 2011, 23(2): 65.
8. 国家卫生健康委员会. 碳青霉烯类耐药肠杆菌预防与控制标准WS/T 826-2023. 中国感染控制杂志, 2023, 22(10): 1274-1278.
9. 黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 2015(1): 1-9.
10. 中华预防医学会医院感染控制分会, 中华医学会感染病学分会, 中国医院协会医院感染管理专业委员会, 等. 中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引. 中华医院感染学杂志, 2019, 29(13): 2075-2080.
11. Zeng M, Xia J, Zong Z, et al. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant Gram-negative bacilli. J Microbiol Immunol Infect, 2023, 56(4): 653-671.
12. Tomczyk S, Zanichelli V, Grayson ML, et al. Control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in healthcare facilities: a systematic review and reanalysis of quasi-experimental studies. Clin Infect Dis, 2019, 68(5): 873-884.
13. Tängdén T, Giske CG. Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspectives on detection, treatment and infection control. J Intern Med, 2015, 277(5): 501-512.
14. Dos Santos WM, Aromataris E, Secoli SR, et al. Cost-effectiveness of antimicrobial treatment for inpatients with carbapenem-resistant Klebsiella pneumoniae infection: a systematic review of economic evidence. JBI Database System Rev Implement Rep, 2019, 17(12): 2417-2451.
15. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
16. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials, 1996, 17(1): 1-12.
17. 黄辉萍, 张世阳, 连羡玉, 等. 接触隔离预防控制耐碳青霉烯类耐药菌传播效果分析. 中华医院感染学杂志, 2017, 27(18): 4098-4101, 4158.
18. 杨小平, 陈琳, 范有芬, 等. 烧伤患者耐碳青霉烯类革兰阴性杆菌感染干预措施效果研究. 中华医院感染学杂志, 2020, 30(6): 861-865.
19. Zhou S, Mi S, Rao X, et al. Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units. Sci Rep, 2023, 13(1): 9527.
20. He L, Fu Z, Wang M, et al. Prevention and treatment of carbapenem-resistant organism bacilli from liver transplantation donors-single center experience. Infect Drug Resist, 2022, 15: 47-52.
21. 殷丽军, 缪瑾, 杨韦菁, 等. 儿童医院重点部门耐碳青霉烯类革兰阴性杆菌主动筛查结合集中安置干预效果评价. 中国感染控制杂志, 2021, 20(5): 443-448.
22. 万玲, 吴晓琴, 刘晴, 等. 透明监管模式防控耐碳青霉烯肠杆菌科细菌医院感染的效果研究. 中华医院感染学杂志, 2019, 29(20): 3170-3174.
23. 李琳, 吴晓琴, 徐莉, 等. 信息化透明监管干预模式对耐碳青霉烯肺炎克雷伯菌医院感染的防控效果. 护理实践与研究, 2023, 20(3): 383-387.
24. 陈亚男, 刘菁, 李爱民, 等. 基于多学科诊疗模式降低重症监护病房碳青霉烯类耐药肠杆菌科细菌感染的效果评价. 中华临床感染病杂志, 2020, 13(3): 182-188.
25. 陈亚男, 刘菁. 医联体内耐碳青霉烯类肠杆菌感染同质化防控管理成效. 中华医院感染学杂志, 2023, 33(11): 1751-1755.
26. Li M, Wang X, Wang J, et al. Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study. Antimicrob Resist Infect Control, 2019, 8: 8.
27. Dai Y, Meng T, Wang X, et al. Validation and extrapolation of a multimodal infection prevention and control intervention on carbapenem-resistant Klebsiella pneumoniae in an epidemic region: a historical control quasi-experimental study. Front Med (Lausanne), 2021, 8: 692813.
28. 王广芬, 王福斌, 袁妍妩, 等. 多模式策略对重症监护病房耐碳青霉烯类肠杆菌干预效果评价. 中国消毒学杂志, 2018, 35(12): 909-911.
29. 陈娟, 何华云, 鞠燕, 等. 抗生素管理及手卫生对新生儿耐碳青霉烯类肠杆菌科细菌感染的影响. 临床儿科杂志, 2014(10): 940-944.
30. 闫岩, 田颖, 耿传营, 等. 循证研究对预防多发性骨髓瘤患者CRE感染的应用效果. 中华医院感染学杂志, 2018, 28(23): 3627-3630.
31. 陈美恋, 王守军, 匡季秋, 等. 重症监护病区CRE主动筛查及其效果评价. 中华医院感染学杂志, 2017, 27(18): 4123-4126.
32. 郭辅政, 朱凤雪, 李纾, 等. 主动筛查对重症监护病房内耐碳青霉烯类肠杆菌感染率的影响. 中国医药, 2018, 13(2): 270-273.
33. 管红艳, 刘婧娴, 陈峰, 等. 儿童重症监护病房耐碳青霉烯类肠杆菌科细菌主动筛查及临床资料分析. 中国感染与化疗杂志, 2021, 21(4): 444-448.
34. 李宁, 陈小会, 周晖, 等. 血液系统恶性肿瘤与实体肿瘤患者碳青霉烯耐药肠杆菌科细菌定植分布特点及主动筛查评价. 浙江医学, 2022, 44(7): 729-732.
35. 黄细莲, 吴盛海, 施鹏飞, 等. 血液科患者肠道碳青霉烯类耐药的肠杆菌科细菌主动筛查及其效果评价. 中华血液学杂志, 2020, 41(11): 932-936.
36. 陈应书, 游树平. 集束化干预措施对重症医学科耐碳青霉烯鲍曼不动杆菌感染的防控效果研究. 中文科技期刊数据库(全文版)医药卫生, 2022(7): 181-183.
37. 张海娇, 杨春艳, 张诤, 等. 基于依从性监测的加强干预对鲍曼不动杆菌感染的防控效果. 中国感染控制杂志, 2022, 21(1): 49-54.
38. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
39. Morgan DJ, Rogawski E, Thom KA, et al. Transfer of multidrug-resistant bacteria to healthcare workers’ gloves and gowns after patient contact increases with environmental contamination. Crit Care Med, 2012, 40(4): 1045-1051.
40. Iordanou S, Palazis L, Timiliotou-Matsentidou C, et al. When multidrug-resistant organism (MDRO)-positive ICU patient isolation and cohorting is not feasible, what comes next?. Cureus, 2021, 13(3): e13636.
41. Belley A, Harris R, Beveridge T, et al. Ultrastructural effects of oritavancin on methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Antimicrob Agents Chemother, 2009, 53(2): 800-804.
42. Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother, 2009, 64(Suppl 1): i11-i17.
43. Martin M, Zingg W, Hansen S, et al. Public reporting of healthcare-associated infection data in Europe. What are the views of infection prevention opinion leaders?. J Hosp Infect, 2013, 83(2): 94-98.
44. 梁艳芳, 赖晓全, 谭莉. 透明监管在医院感染管理中的应用研究. 中华医院感染学杂志, 2020, 30(1): 135-140.
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West China Medical Journal

Prevention and control strategies for carbapenem-resistant organism in medical institutions in China: a meta-analysis

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