Strategies to Reduce Transmission of Antimicrobial Resis

减少抗菌素耐药性传播的策略

• 批准号: 7215818
• 负责人: Naomi P O'Grady
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7215818
• 关键词: Enterococcus; Staphylococcus aureus; antisepsis; bacterial disease; drug resistance; hospital patient care; human subject; intensive care; microorganism culture; nosocomial infection control; patient oriented research; sample collection

This study will determine if rates of colonization and infection with 2 resistant Gram positive bacteria?methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE)?among patients in adult intensive care units (ICUs) are lower in ICUs that use an intensive infection control strategy plus standard care compared to ICUs that use standard care alone. The intensive control strategy involves: 1) identifying patients who are colonized with MRSA or VRE by reporting the results of surveillance cultures of the anterior nares and stool or perianal area; 2) Universal Gloving (use of gloves during interactions with the patient or the patient?s environment) until the patients are discharged or their surveillance culture results show they are not colonized with MRSA or VRE (whichever happens first); and 3) Contact Precautions (use of gloves and gowns during interactions with the patient or the patient?s environment) during care of patients who are colonized with MRSA or VRE. Standard care involves proper hand hygiene (handwashing or use of a waterless hand antiseptic) and use of Standard Precautions (use of gloves and other barriers as needed for interactions involving contact with mucous membranes, wounds, and body fluids) and collection of surveillance cultures, but not reporting of results to these sites. The surveillance cultures will be performed by obtaining swabs of the nose and stool or perianal area from patients upon admission to the ICU, at weekly intervals thereafter, and upon discharge from the ICU. The results of the surveillance cultures will be used to compare the rate of colonization with MRSA and VRE in ICUs using the intensive control strategy with those that use standard care alone. Progress Report: This study is a multi-center trial supported by the National Institute of Allergy and Infectious Diseases (NIAID) and is conducted through the Bacteriology and Mycology Study Group, a clinical trials network funded by NIAID. Male and female patients, ages 18 and above, who are admitted to the MICU, SICU or MICU/SICU at one of the 20 participating sites are eligible for the study. The NIH provides the microbiology for this protocol and has no direct patient contact. The Department of Laboratory Medicine at the NIH performs the microbiology on the samples collected at the participating sites. The NIH lab records the culture results in the BAMBU system. This study has enrolled 2982 patients over a 4 month baseline density data collection period. The 6 month intervention period for those ICUs randomized to the intensive control arm begins January 1, 2006. No data analysis has yet occurred.

本研究将确定成人重症监护病房 (ICU) 患者中 2 种耐药革兰氏阳性菌——耐甲氧西林金黄色葡萄球菌 (MRSA) 和耐万古霉素肠球菌 (VRE) 的定植率和感染率，在使用强化感染控制策略加标准护理的 ICU 中，与仅使用标准护理的 ICU 相比，是否较低。强化控制策略包括： 1) 通过报告前鼻孔和粪便或肛周区域的监测培养结果来识别 MRSA 或 VRE 定植的患者； 2) 通用手套（在与患者或患者环境互动时使用手套），直到患者出院或他们的监测培养结果显示他们没有感染 MRSA 或 VRE（以先发生者为准）； 3) 护理感染 MRSA 或 VRE 的患者期间的接触预防措施（在与患者或患者环境互动时使用手套和防护服）。标准护理包括适当的手部卫生（洗手或使用无水洗手液）和使用标准预防措施（在涉及粘膜、伤口和体液接触的相互作用时根据需要使用手套和其他屏障）以及收集监测培养物，但不向这些地点报告结果。监测培养将通过在患者进入 ICU 时、此后每周一次以及从 ICU 出院时采集患者的鼻子和粪便或肛周区域的拭子来进行。监测培养结果将用于比较使用强化控制策略与仅使用标准护理的 ICU 中 MRSA 和 VRE 的定植率。 进展报告：这项研究是一项由美国国家过敏和传染病研究所 (NIAID) 支持的多中心试验，通过细菌学和真菌学研究组（NIAID 资助的临床试验网络）进行。入住 20 个参与地点之一的 MICU、SICU 或 MICU/SICU 的年龄 18 岁及以上的男性和女性患者有资格参加该研究。 NIH 为该方案提供微生物学数据，并且与患者没有直接接触。美国国立卫生研究院实验医学部对参与地点收集的样本进行微生物学分析。 NIH 实验室将培养结果记录在 BAMBU 系统中。 该研究在 4 个月的基线密度数据收集期内招募了 2982 名患者。那些被随机分配到强化对照组的 ICU 的 6 个月干预期从 2006 年 1 月 1 日开始。尚未进行数据分析。