Evaluation of effectiveness of comprehensive intervention infection prevention and control measures on carbapenem-resistant gram-negative bacilli of drug resistance genes in pediatric hospital in 2017-2021
OBJECTIVE To evaluate the effectiveness of comprehensive interventions for carbapenem-resistant gram-negative bacilli(CR-GNB)in high-risk departments for pediatric hospital-acquired infections(neonatal unit,NICU,PICU,and hematology department)and their resistance genes.METHODS Children in the high-risk de-partments for pediatric hospital-acquired infections of Fudan University Pediatric Hospital were selected as the study subjects from 2017 to 2021,and active screening in the upper respiratory tract and intestines of the above children within 48 hours after admission and once a week during hospitalization was stared in 2017,and centralized placement was implemented for the CR-GNB-positive children detected by the active screening and the clinically delivered specimens from January 2018,and the changes of active screening rate,colonization rate,various patient placement rate,and nosocomial infection rate of CR-GNB were compared.The mechanism of resistance was also investigated by detecting carbapenemase-resistant genes by polymerase chain reaction(PCR).RESULTS The active screening rate of CR-GNB in anal-pharyngeal swabs increased year by year from 2017 to 2021(P＜0.001),and a total of 28.46％(916/3 219)of CR-GNB-positive children in high-risk departments mentioned above were subjec-ted to centralized placement in A/B,and with the increase in the rate of centralized placement in A/B,the rate of CR-GNB colonization in children with hospitalization time＞7 d showed a decreasing trend(P＜0.001),while the rate of nosocomial infections decreased from 1.16％(153/13 190)in 2017 to 0.29％(28/9 774)in 2021(P＜0.001).The predominant carbapenem-resistant Klebsiella pneumoniae resistance genes were blaNDM-i(52.00％,26/50),blaKPC-2(42.00％,21/50),blaDHA-i(26.00％,13/50),while all carbapenem-resistant Acinetobacter bau-mannii were detected with the blaOXA-23 resistance gene,and only three carbapenem-resistant strains of Pseudo-monas aeruginosa were detected with the resistance gene,one with blaBiC,and two with bla viM-2.CONCLUSION Active CR-GNB screening and A/B-related isolation placement measures in departments at high risk for infection could reduce CR-GNB colonization and hospital-acquired infection rates.
Active screeningVarious patient placementsCarbapenem-resistant gram-negative bacilliColoniza-tionKPCNDMOXA-23Effect of comprehensive interention measwreSurveillence of infection
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