Reduce Transmission of Antimicrobial Resistant Bacteria

这是一项为期15个月的多中心研究，旨在确定两种耐药革兰氏阳性细菌——耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）——在成人重症监护病房（icu）患者中，使用强化感染控制策略加标准护理的icu患者的定植和感染率是否低于单独使用标准护理的icu患者。强化控制策略包括：(1)通过使用鼻腔（MRSA）和粪便或肛周区域（VRE）的前瞻性监测培养来识别MRSA或VRE定殖的患者；(2)在患者出院或监测培养结果显示患者无MRSA或VRE定植前，使用通用手套；(3) MRSA或VRE定殖患者护理期间的接触注意事项。分布在美国各地的20家ICU医院将被纳入研究。将在所有患者入ICU时、ICU住院期间每周和出院时收集强化对照人群的监测培养物。所有标本（约180,000）将在临床中心微生物实验室进行处理。采用富集肉汤技术和选择性琼脂培养法对标本进行MRSA或VRE筛选，并采用PCR检测抗性基因。对富集和选择性培养方法进行了初步研究。所有MRSA和VRE阳性标本和分离株将在-80℃保存，以备将来研究。已经设计的研究包括：用PCR直接分析MRSA或VRE标本与传统培养方法的比较；万古霉素中体和耐万古霉素金黄色葡萄球菌流行情况评估；万古霉素依赖性肠球菌患病率评估；20个研究点MRSA和VRE分离株的流行病学克隆性。

This is a 15-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 show they are not colonized with MRSA or VRE; and (3) Contact Precautions during care of patients who are colonized with MRSA or VRE. Twenty ICU sites distributed throughout the US will be enrolled in the study. Surveillance cultures for the intensive control populations will be 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 (approximately 180,000) will be processed in the Clinical Center Microbiology Labs. Specimens will be screened for MRSA or VRE using an enrichment broth technique and selective agar culture methods, and the resistance genes will be detected by PCR. Preliminary work has been performed developing the enrichment and selective culture methods. All positive specimens and isolates of MRSA and VRE will be stored at -80 C for future studies. Studies that have already been designed include: comparison of direct analysis of specimens for MRSA or VRE by PCR with the conventional culture method; assessment of the prevalence of vancomycin-intermediate and vancomycin-resistant S. aureus; assessment of the prevalence of vancomycin-dependent Enterococcus; epidemiologic clonality of MRSA and VRE isolates for the 20 study sites.