Healthcare-related infections are a major global problem, placing a considerable burden on healthcare systems. According to数据在美国疾病控制和预防中心中，大约有31例医院患者在任何一天至少有1个与医疗保健相关的感染。这种并发症导致健康结果差，成本增加和抗生素过度使用，加速抗菌耐药性。确定与医疗保健相关的感染的驱动因素对于预防和治疗良好的抗生素管理至关重要。

Types of healthcare-related infection

与医疗保健相关的感染，也称为医疗医疗感染，是一种感染，在接受患者入院后不存在的医疗保健时获得了一种感染。有around 20 common pathogens in healthcare settings，最令人担忧的是耐甲氧西林金黄色葡萄球菌（MRSA），可能导致严重或潜在的威胁生命的疾病。Infections most often occur after interventions such as surgery or ventilation, or from in-dwelling medical devices such as central lines. One of the most common causes of healthcare-related infections seen in many different healthcare settings, is the use of urinary catheters.¹

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降低室内设备的风险

“In the US and Europe, 40% of hospital infections are urinary tract infections (UTIs), and this is likely to underestimate the global prevalence” saysAna Flores-Mireles, Hawk assistant professor at Notre-Dame University, USA. “There are also important differences between uncomplicated UTIs and catheter-associated UTIs (CAUTIs). Uncomplicated UTIs are more common in young women and the majority of the cases are caused by one organism –Escherichia coli。相比之下，任何年龄的男人和女人都同样容易出现cautis，它们是由一系列微生物引起的。如果未经治疗，cautis也经常导致继发性血液感染，7天死亡率超过30％。”那么，为什么这些类型的UTI的发生率和结果有如此不同？

The answer, says Flores-Mireles, lies in the inflammatory response caused when the catheter continually scratches the bladder lining as it flexes to expand and void urine. “This constant wounding of the bladder wall causes a coagulation response where the body releases many different proteins from the blood into bladder tissue to promote wound healing,” explains Flores-Mireles. One of these proteins, fibrinogen, forms networks around wounds but also coats the catheter. Unlike the normal bladder, which is uninhabitable for non-specialist microbes, the catheter creates the perfect environment for opportunistic species to thrive. “It’s like a bed and breakfast for pathogens,” says Flores-Mireles.

Fibrinogen deposition not only allows microbes to colonize the internal portion of the catheter, it also enables microbes to use the catheter as a hoist to invade the bladder. To prevent this, Flores-Mireles and bio-engineerCaitlin Howell，美国缅因州大学的副教授，着手开发出一种光滑，柔软的导管，不会给病原体带来这种优势。在小鼠的小鼠模型中，一种硅胶油含有硅酮的导管减少了宿主蛋白的沉积 - 导致导管本身上的微生物定殖在膀胱内降低，并防止在整个人体中进一步传播。²Proteomics analysis also showed that the total protein abundance was significantly reduced on the catheter.

“Around 20-50% of patients in hospital or nursing homes have a catheter, often for periods up to 30 days,” says Flores-Mireles. “If the silicone-based catheter is proven to be safe and effective for longer-term use in patients, it could help to reduce CAUTIs in multiple healthcare settings.”

最重要的优点之一是这是一种抗生素的干预措施。“通常仅测试含有抗菌剂的导管in vitro, and this doesn’t reflect the host-driven infection via the inflammatory response,” says Flores-Mireles. “They will still get coated with protein causing them to release sub-therapeutic levels of antibiotics which, in turn, may drive antimicrobial resistance.” If successful, the technology could be extended to prevent infections via central lines or other in-dwelling devices.

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COVID-19的大流行一直在全球范围内继续蔓延，全球感染的数量越来越多，新变体的持续出现。现有的疫苗是否仍针对新变体有效？这些疫苗的保护性如何？这些问题需要紧急回答。下载此白皮书以发现此类问题的答案。

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Preventing transmission between patients

Another important aspect of tackling healthcare-related infections is understanding the factors that influence transmission. In addition to unavoidable risks from having an open wound or an in-dwelling device, infections can also occur if a patient is in contact with contaminated equipment or if healthcare professionals (HCPs) pass on infections between patients during care. Evidence suggests that these risks increase when there is higher bed occupancy, overcrowding of patients and understaffing.^3,4这些系统级别的问题创造了一个恶性循环：一项评论突出了人满为患和人手不足如何导致手动卫生减少以及病房之间的患者和员工的运动增加，从而提高了MRSA感染率。⁴In turn, high MRSA incidence causes increased patient stays, resulting in further overcrowding. So how can we break this cycle?

“I think there are lots of ways to answer this question,” saysEstera Mendelsohna PhD candidate at the Global Digital Health Unit, Imperial College London, UK. “But from my perspective I think it’s important to develop systems that capture high quality and granular data on infections in different healthcare settings as a pre-requisite to good studies on infection risk.”

Mendelsohn说：“这些系统需要使HCP轻松输入数据，而不是去医院进行有关感染风险的前瞻性研究，而是重要的是使用现实世界，常规收集的数据很重要。建立与地面上并了解其医疗保健环境，如何生成数据以及在这种情况下的优先事项的HCP的良好关系也很重要。”

In a recent study, Mendelsohn used electronic health records collected routinely from elderly patients during a hospital stay to examine the impact of hospital ward transfers on infection risk.⁵通过分析24,000多个医院住院，他们发现患者在病房之间移动的次数与感染的几率之间存在正相关。随着每个病房转移，感染的几率增加了9％。

“In this study we had granular detail to our data that allowed us to look at what happened to patients before they tested positive for an infection,” says Mendelsohn. “This was important because one of the first things that happens when a patient becomes infected is that they are moved into a side room, and we needed to exclude those types of transfer from our analysis.”

It’s impossible to say for sure that there is a causal relationship between ward transfers and infections, but what studies like this do is add to the evidence base that clinicians and healthcare managers can use to identify risk factors for infection. “It can help convince them that something they experience anecdotally is backed up by real data, or it can alert them to something completely new,” says Mendelsohn. “The next step is to understand if there is any way we can reduce this patient movement. Some transfers are necessary for a patient’s wellbeing, but others happen because of a shortage of beds and it’s difficult to always send patients to the most appropriate ward. Hopefully, by understanding where these situations of suboptimal patient management impact on healthcare outcomes, we might be able to prevent them. And if we can reduce the lag time between HCPs getting insights from the electronic health record data, through moving towards real-time data management and data dashboards, we might do so even faster.”

参考

1. Hooton TM，Bradley SF，Cardenas DD等。成年人中与导管相关的尿路感染的诊断，预防和治疗：2009年美国传染病学会的国际临床实践指南。Clin Infect Dis。2010;50(5):625-663. doi:10.1086/650482

2. Andersen MJ, Fong C, La Bella AA, et al. Inhibiting host protein deposition on urinary catheters reduces associated urinary tract infections [published online ahead of print, 2022 Mar 29].Elife。2022;11:e75798. doi:10.7554/eLife.75798

3. Kaier K，Mutters NT，Frank U.床入住率和医院获得的感染 - 应该放置空床吗？Clin Microbiol Infect.2012; 18（10）：941-945。doi：10.1111/j.1469-0691.2012.03956.x

4. Clements A, Halton K, Graves N, et al. Overcrowding and understaffing in modern health-care systems: key determinants in methicillin-resistant金黄色葡萄球菌传播。Lancet Infect Dis.2008;8(7):427-434. doi:10.1016/S1473-3099（08）70151-8

5. Boncea EE, Expert P, Honeyford K, et al. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network.BMJ Qual Saf.2021; 30（6）：457-466。doi：10.1136/bmjqs-2020-012124