Does Universal Glove and Gown use decrease carbapenem-resistant Gram-negative bacteria

 描述(由申请人提供)：抗药性细菌与相当大的发病率、死亡率和成本有关。耐药革兰氏阴性细菌的感染率继续上升。正如最近总统科学技术顾问委员会(PCAST)关于抗生素耐药性的报告所概述的那样，需要新的干预措施来遏制抗生素耐药性细菌的传播，包括耐碳青霉烯类抗生素的革兰氏阴性细菌。通过AHRQ合同，我们进行了一项20个ICU群组的随机试验(Bugg研究)，以确定与通常的护理标准相比，所有患者接触时戴手套和穿长袍是否减少了VRE和MRSA的获得；结果发表在《美国医学会杂志》上。研究表明，MRSA的获得率下降了40%，但对VRE的获得率没有影响。MRSA和VRE的不同结果导致许多重症医生、传染病医生、医院流行病学家和医院管理人员不确定是否在他们的ICU实施通用手套和长袍的干预。来自Bugg研究的原始肛周培养被储存起来，以便将来可以分析其他细菌，包括碳青霉烯耐药的革兰氏阴性细菌。目前尚不清楚的是，这项应用将解决的是，在ICU与所有患者接触时戴手套和穿长袍是否会导致耐抗生素的革兰氏阴性细菌减少。这项应用的总体目标是确定所有患者接触时戴手套和穿长袍是否会减少对碳青霉烯类抗生素耐药的革兰氏阴性细菌的获取。我们的中心假设是，干预将有效地减少对碳青霉烯类抗生素耐药的革兰氏阴性细菌的获得。这种应用的基本原理是，Bugg的研究留下了一个重要的问题没有得到回答：通用手套和长袍对碳青霉烯类耐药的革兰氏阴性细菌有什么影响？这项研究的目的是使用已经收集的肛周标本来评估戴手套和穿长袍是否减少了对碳青霉烯类抗生素耐药的革兰氏阴性细菌的获取。拟议的研究的意义在于，它将确定在ICU环境中所有患者接触时戴手套和穿长袍是否会导致碳青霉烯耐药革兰氏阴性细菌的获得减少。这项申请，如果得到资助，成功的可能性非常高，因为拟议的二次分析是基于已经完成的随机分组试验。所有的标本都已经获得，可以非常经济有效的方式进行制作。这使得AHRQ可以回答一个重要的问题，而不需要从头开始资助一项新的随机分组试验。

 DESCRIPTION (provided by applicant): Antibiotic-resistant bacteria are associated with considerable morbidity, mortality, and costs. Infection rates with antibiotic-resistant Gram-negative bacteria continue to increase. As was recently outlined in President's Council of Advisors on Science and Technology (PCAST) report on antibiotic resistance, novel interventions are needed to curb the spread of antibiotic-resistant bacteria including carbapenem-resistant Gram-negative bacteria. Through an AHRQ contract, we performed a 20 ICU cluster randomized trial (BUGG study) to determine if wearing gloves and gowns for all patient contact reduced VRE and MRSA acquisition compared to the usual standard of care; the results were published in JAMA. The study showed a 40% decrease in MRSA acquisition but no effect on VRE acquisition. The differing results for MRSA and VRE led many intensivists, infectious disease physicians, hospital epidemiologists, and hospital administrators to be uncertain about whether to implement the intervention of universal glove and gown in their ICU. The original peri-anal cultures from the BUGG study were stored so that they could be analyzed in the future for other bacteria including carbapenem-resistant Gram- negative bacteria. What is not known that this application will address is whether wearing gloves and gowns for all patient contact in the ICU leads to a decrease in antibiotic-resistant Gram- negative bacteria. The overall objective of this application is to determine whether wearing gloves and gowns for all patient contact leads to a decrease in the acquisition of carbapenem- resistant Gram-negative bacteria. Our central hypothesis is that the intervention will be effective at decreasing the acquisition of carbapenem-resistant Gram-negative bacteria. The rationale for this application is that the BUGG study left an important question unanswered: What is the effect of universal glove and gown on carbapenem-resistant Gram-negative bacteria? The aim of this study is to use already collected peri-anal specimens to assess whether wearing gloves and gowns decreases the acquisition of carbapenem-resistant Gram-negative bacteria. The significance of the proposed research is that it will determine whether wearing gloves and gowns for all patient contact in the ICU setting will lead to a decrease in the acquisition of carbapenem-resistant Gram-negative bacteria. This application, if funded, has an exceedingly high probability of success because the proposed secondary analysis is based on an already completed randomized cluster trial. All of the specimens have been obtained and can be worked up in a very cost-effective manner. This allows AHRQ to answer an important question without funding from scratch a new randomized cluster trial.