Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States
Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States
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DOI：
10.15585/mmwr.mm6430a4
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发表时间：
2015-08-07
影响因子：
33.9
通讯作者：
Jernigan, John A.
中科院分区：
文献类型：
--
作者：
Slayton, Rachel B.;Toth, Damon;Jernigan, John A.
背景资料：由耐药菌和艰难梭菌引起的医疗保健相关感染（HAI）的治疗是有限的，一些患者已经出现无法治疗的感染。证据支持的干预措施是可用的，但协调的方法来中断HAI的传播可能会有更大的影响扭转这些感染的发病率增加比独立的设施为基础的程序effortes.Methods：数据从CDC的国家医疗安全网络和新兴的感染程序进行了分析，以项目的卫生保健相关的耐药细菌或C。无论有没有大规模的国家干预，包括中断传播和改善抗生素管理，都很难。例如，减少一种耐药性感染的传播（碳青霉烯类耐药肠杆菌科[CRE]）对相互关联的卫生保健机构群体内HAI传播事件的累积患病率和数量的影响使用两种不同的方法（大规模和较小规模的卫生保健网络）进行建模。立即在全国范围内进行感染控制和抗生素管理干预，在5年内，可以避免估计619，000例由CRE，多药耐药铜绿假单胞菌，侵袭性耐甲氧西林金黄色葡萄球菌（MRSA），即C.很难与独立的努力相比，一个协调的反应，以防止CRE蔓延到一组相互连接的医疗保健设施，导致累计减少74%的收购超过5年的10设施网络模型，并减少55%超过15年的102设施网络模型。结论：如果现在采取有效行动，5年内可以预防50多万例耐药性卫生保健相关感染。代表大型和小型相互关联的医疗机构的模型表明，协调的方法来中断传输是更有效的比历史上独立的设施为基础的efforts.Implications for Public Health：公共卫生为主导的协调预防方法有可能更彻底地解决这些耐药生物体和C。比独立机构的努力更困难。
Background: Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts.Methods: Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network.Results: Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model.Conclusions: With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facility-based efforts.Implications for Public Health: Public health-led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility-based efforts.