University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia.
Clin Infect Dis. 2011 Jul 1;53(1):49-56. doi: 10.1093/cid/cir273.
Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-β-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients.
管理在多个国家有医疗接触史的患者对许多临床医生来说现在已是现实。休闲旅游、蓬勃发展的医疗旅游行业、军事冲突、自然灾害以及人类迁徙模式的变化都可能促成这一新兴的流行病学趋势。这些人可能既是与医疗相关的耐多药细菌感染的传播媒介，也是受害者。目前的文献描述了耐多药不动杆菌属和肺炎克雷伯菌（包括产碳青霉烯酶肺炎克雷伯菌和新德里金属β-内酰胺酶肺炎克雷伯菌）、耐甲氧西林金黄色葡萄球菌、万古霉素耐药肠球菌和产毒艰难梭菌在国家间的转移。这些生物体被引入新的地点后，在医院内传播。医疗机构应制定完善的感染预防策略，以降低从曾在其他国家住院的患者传播耐多药生物体的风险。临床医生可能还需要根据这些患者存在耐多药生物体的风险，对经验性处方模式进行个体化调整。
