Park Do Hyeon, Choe Pyoeng Gyun
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Ewha Med J. 2024 Jul;47(3):e34. doi: 10.12771/emj.2024.e34. Epub 2024 Jul 31.
The rise of multidrug-resistant organisms represents a serious global public health concern. In Korea, the increasing prevalence of carbapenem-resistant Enterobacterales (CRE) is particularly concerning due to the difficulties associated with treatment. Data from the Korea Global Antimicrobial Resistance Surveillance System indicate a yearly increase in CRE cases, with carbapenemase-producing Enterobacterales being the predominant type. The capacity of CRE to resist multiple broad-spectrum antibiotics leads to higher medical costs and mortality rates, underscoring the need for urgent action. Effective prevention is crucial to curbing CRE outbreaks and transmission. Antimicrobial stewardship programs (ASPs) play a key role and require commitment from healthcare professionals to minimize unnecessary antibiotic use, as well as from policymakers to ensure adherence to ASP guidelines. Given the complexity of CRE transmission, ASP efforts must be integrated with infection control strategies for maximum effectiveness. These strategies include adherence to standard and contact precautions, environmental disinfection, preemptive isolation, and comprehensive education and training for healthcare personnel. Additionally, surveillance testing for patients at high risk for CRE and the use of real-time diagnostic kits can facilitate early detection and reduce further transmission. Strategies for the prevention of CRE infection should be tailored to specific healthcare settings. Ongoing research is essential to update and refine infection control guidelines and effectively prevent CRE outbreaks.
多重耐药菌的出现是一个严重的全球公共卫生问题。在韩国，耐碳青霉烯类肠杆菌科细菌（CRE）患病率的上升尤其令人担忧，因为其治疗存在困难。韩国全球抗菌药物耐药性监测系统的数据表明，CRE病例逐年增加，产碳青霉烯酶肠杆菌科细菌是主要类型。CRE对多种广谱抗生素的耐药能力导致更高的医疗成本和死亡率，凸显了采取紧急行动的必要性。有效的预防对于遏制CRE的暴发和传播至关重要。抗菌药物管理计划（ASP）发挥着关键作用，需要医疗保健专业人员致力于尽量减少不必要的抗生素使用，同时也需要政策制定者确保遵守ASP指南。鉴于CRE传播的复杂性，ASP的努力必须与感染控制策略相结合，以实现最大效果。这些策略包括遵守标准预防措施和接触预防措施、环境消毒、抢先隔离以及对医护人员进行全面的教育和培训。此外，对CRE高危患者进行监测检测以及使用实时诊断试剂盒有助于早期发现并减少进一步传播。预防CRE感染的策略应根据特定的医疗环境进行调整。持续的研究对于更新和完善感染控制指南以及有效预防CRE暴发至关重要。
