Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014.
Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014.
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DOI：
10.1111/ajt.13893
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发表时间：
2016-03-11
期刊：
影响因子：
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通讯作者：
McDonald, L Clifford
中科院分区：
文献类型：
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作者：
Weiner, Lindsey M;Fridkin, Scott K;McDonald, L Clifford
背景：卫生保健相关的抗生素耐药（AR）感染增加了患者的发病率和死亡率，并且可能无法用任何抗生素成功治疗。疾病预防控制中心评估了医疗保健相关感染（HAI），包括艰难梭菌感染（CDI），以及全国几种类型医疗保健设施中最受关注的六种AR细菌的作用。方法：2014年，全美50个州约4000家短期急症护理医院、501家长期急症护理医院和1135家住院康复机构向国家医疗安全网络报告了特定感染的数据。按设施类型计算了国家标准化感染率及其与基准年相比每一种HAI类型的降低百分比。确定2013年美国疾病控制与预防中心强调为紧急或严重威胁的6种耐药细菌中任何一种引起的AR病原体和HAIs的比例。结果：2014年，中央线相关血流感染在短期急症护理医院和长期急症护理医院的发病率分别下降了50%和9%；0%（短期急症护理医院）、11%（长期急症护理医院）和14%（住院康复机构）发生导尿管相关尿路感染；17%（短期急性护理医院）为手术部位感染，8%（短期急性护理医院）为CDI。综合所有情况下除CDI外的HAIs， 47.9%的金黄色葡萄球菌耐甲氧西林，29.5%的肠球菌耐万古霉素，17.8%的肠杆菌科为广谱β -内酰胺酶表型，3.6%的肠杆菌科为碳青霉烯类耐药，15.9%的铜绿假单胞菌耐多药，52.6%的不动杆菌耐多药。六种耐药细菌中任何一种引起HAIs的可能性从住院康复机构的12%到长期急症护理医院的29%不等。结论：尽管在预防一些HAIs方面取得了相当大的进展，但许多剩余的感染可以通过实施现有的推荐做法来预防。根据环境的不同，除CDI外，超过四分之一的hai是由AR细菌引起的。对公共卫生实践的影响：医生、护士和医疗保健领导者需要始终如一地全面遵循所有建议，预防导管和手术相关感染，并通过抗菌药物管理和预防传播措施减少AR细菌的影响。背景：卫生保健相关的抗生素耐药（AR）感染增加了患者的发病率和死亡率，并且可能无法用任何抗生素成功治疗。疾病预防控制中心评估了卫生保健相关感染（HAI），包括艰难梭菌感染（CDI），以及全国几种类型卫生保健设施中最受关注的六种AR细菌的作用。方法：2014年，全美50个州约有4000家短期急症护理医院、501家长期急症护理医院和1135家住院康复机构向国家医疗安全网络报告了特定感染的数据。按设施类型计算了国家标准化感染率及其与基准年相比每一种HAI类型的降低百分比。确定2013年美国疾病控制与预防中心强调为紧急或严重威胁的6种耐药细菌中任何一种引起的AR病原体和HAIs的比例。结果：2014年，中央线相关血流感染在短期急症护理医院和长期急症护理医院的发病率分别下降了50%和9%；0%（短期急症护理医院）、11%（长期急症护理医院）和14%（住院康复机构）发生导尿管相关尿路感染；17%（短期急性护理医院）为手术部位感染，8%（短期急性护理医院）为CDI。综合所有情况下除CDI外的HAIs， 47.9%的金黄色葡萄球菌耐甲氧西林，29.5%的肠球菌耐万古霉素，17.8%的肠杆菌科为广谱β -内酰胺酶表型，3.6%的肠杆菌科为碳青霉烯类耐药，15.9%的铜绿假单胞菌耐多药，52.6%的不动杆菌耐多药。六种耐药细菌中任何一种引起HAIs的可能性从住院康复机构的12%到长期急症护理医院的29%不等。结论：尽管在预防一些HAIs方面取得了相当大的进展，但许多剩余的感染可以通过实施现有的推荐做法来预防。根据环境的不同，除CDI外，超过四分之一的hai是由AR细菌引起的。对公共卫生实践的影响：医生、护士和卫生保健领导者需要始终如一地全面遵循所有建议，预防导管和手术相关感染，并通过抗菌药物管理和预防传播措施减少AR细菌的影响。
BACKGROUND: Healthcare-associated antibiotic-resistant (AR) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. CDC assessed healthcare-associated infections (HAI), includingClostridium difficileinfections (CDI), and the role of six AR bacteria of highest concern nationwide in several types of healthcare facilities.METHODS: During 2014, approximately 4000 short-term acute care hospitals, 501 long-term acute care hospitals, and 1135 inpatient rehabilitation facilities in all 50 states reported data on specific infections to the National Healthcare Safety Network. National standardized infection ratios and their percentage reduction from a baseline year for each HAI type, by facility type, were calculated. The proportions of AR pathogens and HAIs caused by any of six resistant bacteria highlighted by CDC in 2013 as urgent or serious threats were determined.RESULTS: In 2014, the reductions in incidence in short-term acute care hospitals and long-term acute care hospitals were 50% and 9%, respectively, for central line-associated bloodstream infection; 0% (short-term acute care hospitals), 11% (long-term acute care hospitals), and 14% (inpatient rehabilitation facilities) for catheter-associated urinary tract infection; 17% (short-term acute care hospitals) for surgical site infection, and 8% (short-term acute care hospitals) for CDI. Combining HAIs other than CDI across all settings, 47.9% ofStaphylococcus aureusisolates were methicillin resistant, 29.5% of enterococci were vancomycin resistant, 17.8% of Enterobacteriaceae were extended-spectrum beta-lactamase phenotype, 3.6% of Enterobacteriaceae were carbapenem resistant, 15.9% ofPseudomonas aeruginosaisolates were multidrug resistant, and 52.6% of Acinetobacter species were multidrug resistant. The likelihood of HAIs caused by any of the six resistant bacteria ranged from 12% in inpatient rehabilitation facilities to 29% in long-term acute care hospitals.CONCLUSIONS: Although there has been considerable progress in preventing some HAIs, many remaining infections could be prevented with implementation of existing recommended practices. Depending upon the setting, more than one in four of HAIs excluding CDI are caused by AR bacteria.IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Physicians, nurses, and healthcare leaders need to consistently and comprehensively follow all recommendations to prevent catheter- and procedure-related infections and reduce the impact of AR bacteria through antimicrobial stewardship and measures to prevent spread.BACKGROUND: Health care-associated antibiotic-resistant (AR) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. CDC assessed health care-associated infections (HAI), including Clostridium difficile infections (CDI), and the role of six AR bacteria of highest concern nationwide in several types of health care facilities.METHODS: During 2014, approximately 4,000 short-term acute care hospitals, 501 long-term acute care hospitals, and 1,135 inpatient rehabilitation facilities in all 50 states reported data on specific infections to the National Healthcare Safety Network. National standardized infection ratios and their percentage reduction from a baseline year for each HAI type, by facility type, were calculated. The proportions of AR pathogens and HAIs caused by any of six resistant bacteria highlighted by CDC in 2013 as urgent or serious threats were determined.RESULTS: In 2014, the reductions in incidence in short-term acute care hospitals and long-term acute care hospitals were 50% and 9%, respectively, for central line-associated bloodstream infection; 0% (short-term acute care hospitals), 11% (long-term acute care hospitals), and 14% (inpatient rehabilitation facilities) for catheter-associated urinary tract infection; 17% (short-term acute care hospitals) for surgical site infection, and 8% (short-term acute care hospitals) for CDI. Combining HAIs other than CDI across all settings, 47.9% of Staphylococcus aureus isolates were methicillin resistant, 29.5% of enterococci were vancomycin-resistant, 17.8% of Enterobacteriaceae were extended-spectrum beta-lactamase phenotype, 3.6% of Enterobacteriaceae were carbapenem resistant, 15.9% of Pseudomonas aeruginosa isolates were multidrug resistant, and 52.6% of Acinetobacter species were multidrug resistant. The likelihood of HAIs caused by any of the six resistant bacteria ranged from 12% in inpatient rehabilitation facilities to 29% in long-term acute care hospitals.CONCLUSIONS: Although there has been considerable progress in preventing some HAIs, many remaining infections could be prevented with implementation of existing recommended practices. Depending upon the setting, more than one in four of HAIs excluding CDI are caused by AR bacteria.IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Physicians, nurses, and health care leaders need to consistently and comprehensively follow all recommendations to prevent catheter- and procedure-related infections and reduce the impact of AR bacteria through antimicrobial stewardship and measures to prevent spread.