Weber Stephen G, Huang Susan S, Oriola Shannon, Huskins W Charles, Noskin Gary A, Harriman Kathleen, Olmsted Russell N, Bonten Marc, Lundstrom Tammy, Climo Michael W, Roghmann Mary-Claire, Murphy Cathryn L, Karchmer Tobi B
Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
Infect Control Hosp Epidemiol. 2007 Mar;28(3):249-60. doi: 10.1086/512261. Epub 2007 Feb 7.
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
美国至少有两个州已出台立法，旨在通过使用主动监测培养来筛查住院患者，以控制对抗菌药物耐药的病原体。针对该拟议立法，美国医疗保健流行病学学会（SHEA）和感染控制与流行病学专业人员协会（APIC）制定了这份联合立场声明。这两个组织都致力于通过多种方法抗击医疗保健相关感染，包括在适当情况下使用主动监测培养。本立场声明回顾了拟议立法及使用主动监测培养的基本原理，审视了支持使用该策略的科学证据，并讨论了围绕强制使用主动监测培养的立法的一些未解决问题。现提出以下五点共识。（1）尽管减轻包括耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）在内的抗菌药物耐药病原体的负担至关重要，但APIC和SHEA不支持通过立法强制使用主动监测培养来筛查MRSA、VRE或其他抗菌药物耐药病原体。（2）SHEA和APIC支持继续开发、验证和应用有效且具有成本效益的策略，以预防由MRSA、VRE以及其他抗菌药物耐药和抗菌药物敏感病原体引起的感染。（3）APIC和SHEA欢迎医疗保健消费者以及私人、地方、州和联邦政策制定者共同努力，关注抗菌药物耐药性和医疗保健相关感染这一日益严重的问题，并制定解决方案。（4）SHEA和APIC支持持续开展更多研究，以确定并优化使用主动监测培养筛查低风险和高风险人群的适宜性、实用性、可行性和成本效益。（5）APIC和SHEA支持州和地方公共卫生当局与机构感染预防与控制专家之间加强合作。
