Effect of a Nursing Care Bundle on Prevention of Fungal Dermatitis in ICU Patients with Carbapenem-Resistant Enterobacterales

GAO Jing; SHI Wen; CHEN Xuemei

doi:10.11786/sypfbxzz.1674-1293.20260113

Abstract：Objective To evaluate whether a nursing care bundle reduces the incidence and delays the onset of cutaneous fungal infection in intensive care unit(ICU)patients with carbapenem-resistant Enterobacterales(CRE)infection.Methods This randomized study enrolled 94 consecutive CRE-infected patients admitted to the ICU of Nanjing Hospital of C.M.between March 2023 and March 2025.Patients were randomly assigned(random number table)to receive either routine nursing care(control,n=47)or a structured nursing care bundle(intervention,n=47).Outcomes compared included incidence of cutaneous fungal infection,time to onset,ICU length of stay,duration of antibiotic therapy,and clinical course of fungal lesions.Results The care-bundle group had a significantly lower incidence and a later onset of fungal infection compared with controls(both P<0.05).A total of 18 patients developed cutaneous fungal infection.All affected patients received topical antifungal therapy(e.g.,ketoconazole cream)plus skin hygiene measures.After one week,lesions in all four affected patients in the care-bundle group had largely resolved and were judged clinically cured.In the control group,10 of 14 patients improved after one week(reduced lesions and pruritus),while 4 required extended treatment;their symptoms resolved by week two.Patients in the care-bundle group also had shorter ICU stays and shorter durations of antibiotic use than controls(P<0.05).Conclusion Implementation of a nursing care bundle in the ICU was associated with a lower incidence and delayed onset of cutaneous fungal infection among patients with CRE infection,along with shorter ICU stays and reduced antibiotic exposure.