Ustanova zaposlenja: UKC Ljubljana (SLOVENIA)

Ključne riječi: Control swabs, MRSA, VRE, ESBL, multiresistant bacteria, intensive therapy unit

Kongres/Simpozij: ”5. Međunarodni kongres HDMSARIST-a” i ”8. Međunarodni kongres WFCCN-a”

Mjesto i vrijeme održavanja: Šibenik, 12.-15. travnja 2012. godine

Most of the patients in the intensive therapy unit receive antibiotics. The resistance of bacteria isolated in the intensive therapy unit is higher that in ordinary hospital units. Nowadays we encounter gram-negative bacteria with increasing frequency in the intensive therapy units in addition to gram-positive bacteria. The most common and also most important causes of infection and colonisation with mutliresistant bacteria are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended spectrum betalactamases (ESBL).
The measures for reducing the occurrence for hospital-acquired infections caused by mutliresistant bacteria are complex; therefore they have to be interconnected and must be implemented consistently. The collection of control swabs in patients upon admission to the intensive therapy unit and the subsequent tracking and repetition of the collection of control swabs during hospitalization in the intensive therapy unit, the implementation of isolation measures in patients, who are colonized or infected with multiresistant bacteria, the correct and consistent hand hygiene, disinfecting equipment and accessories in contact with a colonized/infected patient, and rational use of antibiotics are arguably the most important measures for prevention of the spread of hospital-acquired infections caused by multiresistant bacteria in intensive therapy units as well as in other hospital units.
The most important control swabs for detecting the MRSA carriers are nose swabs, skin fold swabs of undamaged skin, wounds or skin lesion swabs, throat swabs or tracheal aspirations in artificial ventilated patients, and rectum swabs. Rectum and perineum swabs are the most suitable for detecting the VRE carrier. And rectum swabs and stool tests are the most appropriate for detecting the ESBL carrier. Other control swabs can also be taken such as a wound swab, if a wound is present, the tracheal aspiration in intubated patients, a throat swab and a skin fold swab. In patients with an inserted urinary catheter the appropriate control swab is urine.
In the Intensive therapy unit of the University Medical Centre in Ljubljana – at the Clinic for Infectious Diseases and Febrile Illnesses – 142 patients have been hospitalized in the period from 1.6. – 30.11. 2011. The average length of stay in the hospital was 12 days. We collected control swabs for MRSA from all new admitted patients at their admission: nose swabs, throat swabs or the tracheal aspirations in intubated patients, skin fold swabs, rectum swabs and wound swabs. For VRE and ESBL we collected rectum swabs, throat swabs or tracheal aspirations in intubated patients, skin fold swabs and wound swabs. The control swabs were repeated on the third, seventh, tenth, fourteenth, seventeenth and twenty-first day of hospitalization. After the twenty-first day the swabs were collected every seven days until the patients dismissal from the intensive therapy unit.
We collected 4311 control swabs from all hospitalized patients in the research period from 1.6. – 30.11. 2011, of which 1744 (40 %) were collected for MRSA, 1250 (29 %) for ESBL, and 1309 (31 %) for VRE. The total number of positive control swabs was 380, of which 68 swabs were positive to MRSA, 310 swabs were positive to ESBL, and 2 were positive for VRE.
We discovered only one patient with VRE with the admission control swabs.
Measures, which reduce the occurrence of multiresistant bacteria and prevent their spread, are of the utmost importance in avoiding hospital-acquired infection expansions caused by multiresistant bacteria. Clearly, active detection of colonized patients is one of the most important measures for preventing hospital-acquired infection expansions.