Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms_West China Medical Journal

Authors：

SUN Rui ¹ ,  CHEN Liping ¹ , XIAO Yaxiong ² , WANG Mingqun ³ , LEI Xibing ¹ , TAN Muyang ¹ , TANG Yan ¹

1. Office of Hospital Infection Management, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;
2. Department of Laboratory, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;
3. Department of Pharmacy, the First People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;

Corresponding author：

CHEN Liping, Email: 1837639492@qq.com

Keywords：

Multi-disciplinary team management mode; Management of multidrug-resistant organisms; Practice; Continuous improvement

DOI：

10.7507/1002-0179.201901150

Video：

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Objective To explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).Methods In 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.Results The detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ²=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ²=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.Conclusion The MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.

Citation： SUN Rui, CHEN Liping, XIAO Yaxiong, WANG Mingqun, LEI Xibing, TAN Muyang, TANG Yan. Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms. West China Medical Journal, 2019, 34(3): 256-261. doi: 10.7507/1002-0179.201901150 Copy

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1. Günther F, Kaiser SJ, Fries T, et al. Susceptibility of multi-drug resistant clinical pathogens to a chlorhexidine formulation. J Prev Med Hyg, 2015, 56(4): E176-E179.
2. 中华人民共和国国家卫生健康委员会. 卫生部办公厅关于加强多重耐药菌医院感染控制工作的通知(卫办医发〔2008〕130号). (2008-06-27) [2019-01-20]. http://www.nhfpc.gov.cn/zwgk/wtwj/201304/caa37dae8bde44bc9a42dd10aeb9ff43.shtml.
3. 顾忠民, 吴荣华. PCT 在 ICU 多重耐药菌 MDR 的定植与感染鉴别中的应用. 中国医药科学, 2012, 2(11): 90-91.
4. Schuetz P, Albrich WC, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med, 2011, 9: 107.
5. 孙吉花, 于苏国, 陈晓琳, 等. 多学科协作模式在医院感染预防控制中的应用及管理. 中华医院感染学杂志, 2010, 20(17): 2639-2641.
6. 魏瑛琪, 关纯, 邱蔓, 等. 多学科协作与多部门联动预防控制多药耐药菌医院感染. 中华医院感染学杂志, 2011, 21(12): 2595-2596.
7. 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, 14(1): 1-9.
8. 中华人民共和国国家卫生和计划生育委员会办公厅. 国家卫生计生委办公厅关于印发麻醉等 6 个专业质控指标(2015 年版)的通知. (2015-03-31) [2019-01-20]. http://www.nhfpc.gov.cn/yzygj/s3585/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
9. 葛芳, 黄丽晴, 毛美琴. 多重耐药菌感染的危险因素与防控措施. 中国消毒学杂志, 2017, 34(3): 292-294.
10. 王媛媛, 孙颖, 林锦彦, 等. 多学科协作提高健康管理质量控制水平的研究. 中华健康管理学杂志, 2015, 9(4): 316-317.
11. 嵇晓红, 刘春湘, 陈嫣红, 等. 多学科协作模式在多重耐药菌医院感染控制中应用的效果观察. 重庆医学, 2013, 42(19): 2254-2256.
12. 雷曦兵, 黄薇, 陈丽萍, 等. 某三级甲等综合医院 2013 年–2015 年多重耐药菌监测情况分析. 华西医学, 2017, 32(3): 334-338.
13. 中华人民共和国国家卫生和计划生育委员会合理用药专家委员会, 全国细菌耐药监测网. 2015 年全国细菌耐药监测报告. 中国执业药师, 2016, 13(3): 3-8.
14. 李耘, 吕媛, 薛峰, 等. 中国细菌耐药监测研究 2013 至 2014 年非发酵革兰阴性菌监测报告. 中华检验医学杂志, 2016, 39(2): 130-138.
15. 肖淑珍, 徐桂婷, 方洁, 等. 鲍曼不动杆菌耐药性与抗菌药物使用情况的相关性分析. 中国感染与化疗杂志, 2013, 13(6): 446-449.
16. 中华人民共和国国家卫生和计划生育委员会. 抗菌药物临床应用管理办法(卫生部令第 84 号). (2012-04-24) [2019-01-20]. http://www.moh.gov.cn/mohyzs/s3584/201205/54645.shtml.
17. 中华人民共和国国家卫生和计划生育委员会办公厅, 国家中医药管理局, 解放军总后勤部卫生部药品器材局. 关于印发抗菌药物临床应用指导原则(2015 年版)的通知. (2015-07-24)[2019-01-20]. http://www.gov.cn/xinwen/2015-08/27/content_2920799.htm.
18. 中华人民共和国国家卫生和计划生育委员会办公厅. 国家卫生计生委办公厅关于进一步加强抗菌药物临床应用管理遏制细菌耐药的通知(国卫办医发〔2017〕10 号). (2017-02-27)[2019-01-20]. http://www.nhfpc.gov.cn/yzygj/s7659/201703/d2f580480cef4ab1b976542b550f36cf.shtml.
19. 雷曦兵, 陈丽萍, 肖亚雄, 等. 某三级甲等医院实施多重耐药防控干预效果研究. 华西医学, 2016, 31(3): 406-413.

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Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms

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