Larson Elaine L, Quiros Dave, Giblin Tara, Lin Susan
School of Nursing, Columbia University, New York, NY 10032, USA.
Am J Crit Care. 2007 Mar;16(2):110-20.
Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals.
To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention.
An on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression.
Resistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046).
Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.
抗生素的不当使用以及未遵守感染控制预防措施导致医院内抗菌药物耐药性水平不断上升。
评估感染控制项目中耐药性监测的程度，并将耐药率与抗菌药物控制政策的特点、医护人员的态度和做法以及疾病控制与预防中心手部卫生指南实施情况的系统层面指标相关联。
对美国33家医院的重症监护室工作人员和感染控制主任进行了现场调查。收集了以下数据：抗菌药物控制政策；过去12个月中耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌和耐头孢他啶肺炎克雷伯菌的发生率；实施该指南的系统层面工作的实施得分；工作人员对实践指南的态度；以及对工作人员手部卫生的观察情况。通过逻辑回归分析与耐药率相关的变量的独立影响。
金黄色葡萄球菌、肠球菌和肺炎克雷伯菌的耐药率分别为52.5%、18.2%和16.0%。10家（30.3%）医院有抗生素控制政策。在工作人员对实践指南的态度、观察到的手部卫生行为或是否有抗生素使用政策与耐药率之间未观察到统计学上的显著相关性。在逻辑回归分析中，实施该指南的系统层面工作措施得分较高与耐金黄色葡萄球菌和肠球菌的发生率较低相关（P = 0.046）。
独立于个体临床医生实践的组织层面因素可能与抗菌药物耐药率相关。
