肺移植术后多学科协作管理模式对耐碳青霉烯类肠杆菌感染控制的效果分析
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R181.3+2 R378.2

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江苏省医院协会医院管理创新研究课题(JSYGY3-2023-326)


Effect of multi-disciplinary team management mode on the control of carbapenem-resistant Enterobacterales infection after lung transplant surgery
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    摘要:

    目的 评估多学科协作(MDT)管理模式对肺移植术后耐碳青霉烯类肠杆菌(CRE)感染的防控效果,并探讨肺移植术后CRE感染的影响因素。方法 选择无锡市人民医院肺移植中心2014年1月—2023年7月的654例肺移植手术受者作为研究对象,按照实施MDT管理模式的时间节点,将2014年1月—2019年12月的肺移植受者归为对照组,未实施MDT管理模式;2020年1月—2023年7月的肺移植受者归为干预组,实施MDT管理模式。采用Kaplan-Meier法计算肺移植受者术后90 d的CRE感染风险。采用Cox回归模型对住院日数、手术时长、三管日数等变量进行调整,分析实施MDT管理模式对于CRE感染风险的影响。结果 654例肺移植受者共发生医院感染215例,其中对照组158例,医院感染发病率为38.54%;干预组57例,医院感染发病率23.36%,干预组肺移植受者医院感染发病率低于对照组(χ2=15.965,P<0.001);CRE感染共74例,干预组CRE感染发病率低于对照组[7.79%(19/244) VS 13.41%(55/410);χ2=4.828,P=0.028]。至90 d随访期结束,对照组与干预组肺移植受者累计感染风险分别为14.67%、8.26%,两组差异具有统计学意义(P<0.05)。实施MDT管理模式是肺移植受者术后CRE感染的保护因素,而手术时长、呼吸机使用日数、导尿管插管日数则是CRE感染的危险因素(均P<0.05)。结论 在肺移植受者中实施MDT管理模式可有效降低术后CRE感染风险,不断规范与落实医院多重耐药菌MDT管理是预防CRE感染与控制传播的重要手段。

    Abstract:

    Objective To evaluate the effect of multi-disciplinary team (MDT) management mode on the prevention and control of carbapenem-resistant Enterobacterales (CRE) infection after lung transplant surgery, and explore the influencing factors for CRE infection after lung transplant. Methods A total of 654 lung transplant recipients from Lung Transplant Center of Wuxi People’s Hospital from January 2014 to July 2023 were selected as the research subjects. According to the time nodes of the implementation of MDT management mode, lung transplant recipients from January 2014 to December 2019 were assigned to the control group without implementation of MDT management mode. Lung transplant recipients from January 2020 to July 2023 were in the intervention group with MDT management mode implementation. Kaplan-Meier method was used to calculate the risk of CRE infection in lung transplant recipients 90 days after surgery. Cox regression model was used to adjust variables such as length of hospital stay, surgical duration, and catheterization days of three catheters, and the effect of implementing MDT management mode on the risk of CRE infection was analyzed. Results Among 654 lung transplant recipients, 215 had healthcare-associated infection(HAI), including 158 cases from the control group and 57 from the intervention group, with HAI rates of 38.54% and 23.36%, respectively. The incidence of HAI in lung transplant recipients in the intervention group was lower than that in the control group (χ2=15.965, P<0.001). A total of 74 cases of CRE infection were confirmed, and CRE infection rate in the intervention group was lower than that in the control group (7.79% [19/244] vs 13.41% [55/410];χ2=4.828, P=0.028). By the end of the 90-day follow-up period, the cumulative infection risks of the control group and intervention group were 14.67% and 8.26%, respectively, with a statistically significant difference between the two groups (P<0.05). The implementation of MDT management mode was a protective factor for post-operative CRE infection in lung transplant recipients, while duration of surgery, duration of ventilator use, and duration of urinary catheterization were risk factors for CRE infection (all P<0.05). Conclusion Implementing MDT management mode in lung transplant recipients can effectively reduce the risk of post-operative CRE infection. Continuously standardizing and implementing MDT management of multidrug-resistant organisms in hospitals is an important mean of preventing CRE infection and controlling transmission.

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龚裕卿,仇桑桑,黄琴红,等.肺移植术后多学科协作管理模式对耐碳青霉烯类肠杆菌感染控制的效果分析[J]. 中国感染控制杂志,2025,24(8):1089-1096. DOI:10.12138/j. issn.1671-9638.20256918.
GONG Yuqing, QIU Sangsang, HUANG Qinhong, et al. Effect of multi-disciplinary team management mode on the control of carbapenem-resistant Enterobacterales infection after lung transplant surgery[J]. Chin J Infect Control, 2025,24(8):1089-1096. DOI:10.12138/j. issn.1671-9638.20256918.

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  • 收稿日期:2024-08-27
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  • 在线发布日期: 2025-08-19
  • 出版日期: 2025-08-28