Strategies to Reduce Transmission of Antimicrobial Resis

减少抗菌素耐药性传播的策略

• 批准号: 7332519
• 负责人: Patrick R Murray
• 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/7332519
• 关键词: Strategies; Reduce; Transmission; Antimicrobial; Resis

This is an 18-month multicenter study to determine if rates of colonization and infection with 2 resistant Gram-positive bacteria ? methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (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 the use of prospective surveillance cultures of the anterior nares (for MRSA) and stool or perianal area (for VRE); (2) Universal Gloving until the patients are discharged or their surveillance culture results shoe they are not colonized with MRSA or VRE; and (3) Contact Precautions during care of patients who are colonized with MRSA or VRE. Nineteen ICU sites distributed throughout the US are enrolled in the study. Surveillance cultures for the intensive control populations are collected on all patients at the time of admission to the ICU, weekly during their ICU stay, and at the time of discharged. All specimens are processed in the Clinical Center Microbiology Lab. Specimens are screened for MRSA or VRE using an enrichment broth technique and selective agar culture methods, and the resistance genes are detected by PCR. The study will be completed in September 2006 and the data analysis will continue to the end of the year. During the first 16 months of the study, 47,899 specimens were processed ? 23,728 anterior nares swabs for MRSA and 24,171 perianal/stool swabs for VRE. A total of 3,047 nares swabs were positive for MRSA (12.8%) and 5,776 perianal/stool swab for VRE (24.0%). The incidence of VRE and MRSA colonization varied for each ICU and from month to month. All isolates of MRSA and VRE have been stored at -80 C for future studies, such as characterization of the resistance genes, assessment of resistance to other antibiotics (e.g., vancomycin resistance in MRSA), and epidemiologic analysis for strain to strain differences. Additional studies have been initiated to compare culture techniques with direct detection of resistant bacteria by nucleic acid amplification techniques.

这是一项为期18个月的多中心研究，旨在确定2种耐药革兰氏阳性菌的定植率和感染率？与仅使用标准护理的ICU相比，使用强化感染控制策略加标准护理的ICU中成人重症监护病房（ICU）患者中耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）的比例较低。强化控制策略包括：（1）通过使用前鼻孔的前瞻性监测培养来识别MRSA或VRE定植的患者（2）在患者出院或其监测培养结果表明他们没有被MRSA或VRE定殖之前，通用手套;和（3）在护理MRSA或VRE定植患者期间的接触预防措施。本研究入组了分布在美国各地的19家ICU研究中心。在所有患者入住ICU时、ICU期间每周一次以及出院时，收集强化对照人群的监测培养物。所有标本均在临床中心微生物实验室进行处理。使用增菌肉汤技术和选择性琼脂培养方法对标本进行MRSA或VRE筛查，并通过PCR检测耐药基因。研究将于2006年9月完成，数据分析将持续到年底。在研究的前16个月，处理了47,899份标本。23，728份前鼻孔拭子用于MRSA，24，171份肛周/粪便拭子用于VRE。共有3，047份鼻孔拭子对MRSA呈阳性（12.8%），5，776份肛周/粪便拭子对VRE呈阳性（24.0%）。VRE和MRSA定植的发生率在每个ICU和每个月都不同。MRSA和VRE的所有分离株都已储存在-80 ℃下用于未来的研究，例如表征耐药基因，评估对其他抗生素的耐药性（例如，MRSA的万古霉素耐药性），以及菌株间差异的流行病学分析。已经启动了其他研究，以比较培养技术与通过核酸扩增技术直接检测耐药菌。