Strategies to Reduce Transmission of Antimicrobial Resis

这是一项为期18个月的多中心研究，旨在确定2种耐药革兰氏阳性细菌的定殖率和感染率？在成人重症监护病房(ICU)的患者中，耐甲氧西林金黄色葡萄球菌(MRSA)和万古霉素耐药肠球菌(VRE)-与仅使用标准护理的ICU相比，使用重症感染控制策略和标准护理的ICU患者的比例较低。强化控制策略包括：(1)通过对前鼻孔(MRSA)和粪便或肛周区域(VRE)进行前瞻性监测培养，识别出携带MRSA或VRE的患者；(2)普遍戴手套，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；以及(3)在护理感染MRSA或VRE的患者期间采取接触预防措施。分布在美国各地的19个ICU地点参加了这项研究。在所有患者入院时、每周住ICU期间和出院时收集强化控制人群的监测培养。所有标本均在临床中心微生物学实验室处理。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筛选，并通过聚合酶链式反应检测耐药基因。这项研究将于2006年9月完成，数据分析将持续到年底。在前16个月的研究中，对47,899个样本进行了处理？23,728个前鼻孔拭子用于MRSA，24,171个肛周/大便拭子用于VRE。共有3047份鼻拭子检出MRSA(12.8%)，5776份肛周/大便拭子(24.0%)检出VRE。VRE和MRSA定植的发生率在每个ICU和每个月都不同。所有MRSA和VRE分离株都已储存在-80℃下，以供未来研究，如耐药基因的特征，对其他抗生素的耐药性评估(例如，MRSA对万古霉素的耐药性)，以及对菌株之间差异的流行病学分析。已经开始了其他研究，以比较培养技术与通过核酸扩增技术直接检测耐药细菌。

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.