Strategies to Reduce Transmission of Antimicrobial Resis

本研究将确定2种耐药革兰氏阳性菌的定植率和感染率。耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）？与单独使用标准护理的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）患者的死亡率较低。强化控制策略包括：1)通过报告鼻腔、粪便或肛周区域的监测培养结果来识别MRSA或VRE定殖的患者；2)通用手套(在与患者或患者互动时使用手套？直到患者出院或其监测培养结果显示患者未定植MRSA或VRE（以先发生者为准）；3)接触预防措施(在与患者或患者接触时使用手套和防护服？(5)在MRSA或VRE定殖患者的护理期间。标准护理包括适当的手卫生（洗手或使用无水洗手消毒剂）和使用标准预防措施（在接触粘膜、伤口和体液等相互作用时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。监测培养将在患者入ICU时、此后每隔一周以及从ICU出院时采集鼻、粪便或肛周区域拭子进行。监测培养的结果将用于比较重症监护病房中使用强化控制策略与单独使用标准护理策略的MRSA和VRE定殖率。

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 Clinical Center provides the microbiology support for this protocol and has no direct patient contact. All microbiology specimens from participating sites are sent to the Department of Laboratory Medicine. The specimens are processed and recorded in the BAMBU database. In addition to providing microbiology support for the participating sites, several sub-studies are underway testing novel rapid diagnostic tools for MRSA and VRE against culture results. We have enrolled 20,059 patients and the study is now closed for enrollment. (Last day for enrollment was August 25, 2006). Data analysis is underway and should be complete by years end.