Division of Geriatric Medicine, Veterans Affairs Ann Arbor Health Service Research and Development Center of Excellence, Ann Arbor, MI 48105, USA.
Clin Infect Dis. 2011 Mar 1;52(5):654-61. doi: 10.1093/cid/ciq205.
Infections in skilled nursing facilities (SNFs) are common and result in frequent hospital transfers, functional decline, and death. Colonization with multidrug-resistant organisms (MDROs) - including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacilli (R-GNB) - is also increasingly prevalent in SNFs. Antimicrobial resistance among common bacteria can adversely affect clinical outcomes and increase health care costs. Recognizing a need for action, legislators, policy-makers, and consumer groups are advocating for surveillance cultures to identify asymptomatic patients with MDROs, particularly MRSA in hospitals and SNFs. Implementing this policy for all SNF residents may be costly, impractical, and ineffective. Such a policy may result in a large increase in the number of SNF residents placed in isolation precautions with the potential for reduced attention by health care workers, isolation, and functional decline. Detection of colonization and subsequent attempts to eradicate selected MDROs can also lead to more strains with drug resistance. We propose an alternative strategy that uses a focused multicomponent bundle approach that targets residents at a higher risk of colonization and infection with MDROs, specifically those who have an indwelling device. If this strategy is effective, similar strategies can be studied and implemented for other high-risk groups.
在熟练护理设施 (SNF) 中，感染很常见，导致频繁的医院转院、功能下降和死亡。耐多药生物体 (MDRO) 的定植 - 包括耐甲氧西林金黄色葡萄球菌 (MRSA)、万古霉素耐药肠球菌 (VRE) 和多药耐药革兰氏阴性杆菌 (R-GNB) - 在 SNF 中也越来越普遍。常见细菌的抗生素耐药性会对临床结果产生不利影响并增加医疗保健成本。立法者、政策制定者和消费者团体认识到需要采取行动，他们主张进行监测培养，以识别无症状的 MDRO 患者，特别是医院和 SNF 中的 MRSA。对所有 SNF 居民实施这项政策可能代价高昂、不切实际且无效。这样的政策可能会导致大量 SNF 居民被隔离预防措施，医护人员的关注度可能降低，导致隔离和功能下降。检测定植和随后试图根除选定的 MDRO 也可能导致更多具有耐药性的菌株。我们提出了一种替代策略，该策略使用有针对性的多组分捆绑方法，针对具有更高 MDRO 定植和感染风险的居民，特别是那些有留置装置的居民。如果这种策略有效，可以研究和实施类似的策略来针对其他高风险群体。
