Goldmann D A, Huskins W C
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Clin Infect Dis. 1997 Jan;24 Suppl 1:S139-45. doi: 10.1093/clinids/24.supplement_1.s139.
The rapid emergence and dissemination of antimicrobial-resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. The root causes of this problem are multifactorial, but the core issues are clear. The emergence of antimicrobial resistance is highly correlated with selective pressure that results from inappropriate use of antimicrobial agents. Dissemination of resistant organisms is facilitated by person-to-person transmission due to inconsistent application of basic infection control practices by hospital personnel. While control strategies exist, the interventions are not likely to be successful unless hospital leaders assume the responsibility for control of antimicrobial resistance. Strategic goals for the control of resistant organisms should be formulated on the basis of multidisciplinary input from hospital personnel. Processes and outcomes relevant to these strategic goals should be measured, and the resultant data should be used to design, implement, and evaluate systematic measures to increase the appropriate use of antimicrobial agents and basic infection control practices. This approach is as relevant to hospitals in countries with limited resources as it is to in fully industrialized countries.
全球医院中抗菌药物耐药微生物的迅速出现和传播是一个具有危机规模的问题。这个问题的根源是多方面的，但核心问题很明确。抗菌药物耐药性的出现与抗菌药物使用不当导致的选择压力高度相关。医院工作人员基本感染控制措施应用不一致，通过人际传播促进了耐药菌的传播。虽然存在控制策略，但除非医院领导承担起控制抗菌药物耐药性的责任，否则这些干预措施不太可能成功。应根据医院工作人员的多学科意见制定控制耐药菌的战略目标。应衡量与这些战略目标相关的过程和结果，并将所得数据用于设计、实施和评估系统措施，以增加抗菌药物的合理使用和基本感染控制措施。这种方法对于资源有限国家的医院和完全工业化国家的医院同样适用。
