抗生素管理和水平感染控制比筛查、隔离和根除更有效。
Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication.
机构信息
Department of Infection Control and Infectious Diseases, Universtiy Hospital RWTH Aachen, 52074, Aachen, Germany.
出版信息
Infection. 2018 Oct;46(5):581-590. doi: 10.1007/s15010-018-1137-1. Epub 2018 May 23.
PURPOSE
The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of "screening, isolation and eradication" as recommended by many infection control guidelines today.
METHODS
A review of the literature.
RESULTS
The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures.
CONCLUSIONS
In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.
目的
多药耐药菌（MDROs）的全球兴起令人严重关切，因为这些病原体引起的感染难以治疗，在某些情况下甚至无法治疗。本综述将讨论一种非病原体依赖性的替代方法的有效性，该方法包括实施抗生素管理（ABS）计划、提高手卫生依从性以及每天使用抗菌沐浴液，而不是当今许多感染控制指南所推荐的“筛查、隔离和根除”。
方法
文献复习。
结果
由筛查、隔离和根除组成的经典方法存在许多局限性，包括筛查方法缺乏标准化、隔离患者的医疗差错风险以及未能根除耐药菌。值得注意的是，目前的感染控制方法实际上可以预防传播的具体证据仍然缺乏。我们发现，传染病专家培训的新方法可以减少抗菌药物的使用，从而显著减少新的 MDRO 的出现。此外，提高手卫生依从性不仅可以减少 MDRO 的传播，还可以减少引起大多数医院感染的敏感病原体的传播。此外，继续教育、床边观察和使用新工具（例如电子可穿戴设备和配备 Wi-Fi 的分配器）等工具也是可以提高当前低手卫生依从性水平的选择。此外，每天使用抗菌沐浴液可减少 MDRO 的传播，特别是在特定环境中源自体表的 MRSA 和 VRE。最后，抗菌沐浴液在降低传播率方面与筛查和隔离措施具有相似的效果。
结论
总之，本综述描述了一种针对日益增多的 MDRO 这一日益严重的医学挑战的新型基于证据的方法。
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