1946-2005医疗相关感染暴发调查-美国CDC（附全文）

楚楚

Am J Epidemiol. 2011 Dec 1;174(11 Suppl):S47-64.

Health care-associated infection outbreak investigations by the Centers for Disease Control and Prevention, 1946-2005.

Archibald LK, Jarvis WR.

Source

Division of Infectious Diseases, College of Medicine, University of Florida, 1600 SWArcher Road, Room R2-124, PO Box 100277, Gainesville, FL 32610-0277, USA. larchibald@rtix.com

Abstract

Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science. During 1946-2005, CDC Epidemic Intelligence Service officers conducted 531 outbreak investigations in facilities across the United States and abroad. Initially, the majority of outbreaks involved gastrointestinal tract infections; however, in later years, bloodstream, respiratory tract, and surgical wound infections predominated. Among pathogens implicated in CDC outbreak investigations, Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, nonfermentative Gram-negative bacteria, or yeasts predominated, but unusual organisms (e.g., the atypical mycobacteria) were often included. Outbreak types varied and often were linked to transfer of colonized patients or health care personnel between facilities (multihospital outbreaks), national distribution of contaminated products, use of invasive medical devices, or variances in practices and procedures in health care environments (e.g., intensive care units, water reservoirs, or hemodialysis units). Through partnerships with health care facilities and local and state health departments, outbreaks were terminated and lives saved. Data from investigations invariably contributed to CDC-generated guidelines for prevention and control of health care-associated infections.

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鬼才

谢谢楚管的分享。能否给出全文？学习这篇文章，对研究感染控制流行病学很有帮助。应用流行病学方法展开对医疗相关感染暴发的调查，这中间有许多技巧值得我们学习。
从摘要中就可以看出这是一篇十分优秀的现场流行病学文献。

细菌耐药

非常好的医院感染暴发资料！

桂花香

最近几年，暴发出现在血流感染、呼吸道感染和手术部位感染。在我国，手术部位感染的暴发应该是有发生，但是真正的病原体是什么，有时候却没有得到确认。而血流感染的暴发，似乎更难确定。

鬼才

[摘要]自1946年以来,美国疾病控制与预防中心(CDC)研究人员对感染和不良事件的爆发有关医疗保健的问题进行了调查。疾病控制和预防中心的官员已经通过逐步应用这些爆发流行病学、统计、实验室科学对流行情况进行现场调查。在1946 - 2005年期间,疾控中心传染病情报服务人员对美国和国外的51年流感爆发进行设施调查。最初,大部分是胃肠道感染爆发;然而,在以后的岁月里,血液、呼吸道、手术伤口感染盛行。在CDC调查爆发事件的病原体中，金黄色葡萄球菌、肠道杆菌,非发酵革兰氏阴性细菌、酵母菌盛行,但不寻常的生物(例如,非典型分枝杆菌)通常都包括在内。各种通常和多变的爆发类型, 病原菌定植传播患者或健康保健人员之间设施(多医院爆发)、受污染产品的国家分布,侵袭性医疗器械的使用、或在健康医疗环境和流程变化中的操作有关 (例如,重病特别护理病房、水箱、或血液透析单元)。通过与医疗设施相关的,和当地和国家卫生部门相关的合作，终止了爆发并挽救了生命。调查数据有助于CDC编辑预防和控制健康相关感染的指南。
一点请教：在本文的翻译过程中，“national distribution”中的“national ”一词出现在这里，本人不知如何理解。翻译成“受染污产品的(民族或国家)分布”在这里是明显不妥的，我怀疑“national ”是否是“natural”的笔误，请高手给予指教。对这一问题我一直在不解之中。如是我在翻译中就省略了“national”一词。
根据细菌耐药老师的查证，我又作了一个修改，在此对细菌耐药老师表示感谢。同时也对提供原文的楚楚老师表示感谢，使我们有了一次探索学术严谨性的切身体会。

细菌耐药

鬼才 发表于 2012-2-26 10:38

                               
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[摘要]自1946年以来,美国疾病控制与预防中心(CDC)研究人员对感染和不良事件的爆发有关医疗保健的问题进行了 ...

非常好的问题，我也很是困惑，阅读全文试试：

We reviewed CDC archived data on all onsite investigations
conducted by EISOs during 1946–2005. Next, we attempted
to identify which of these outbreaks occurred in
health care settings. In addition, we conducted an online
search of PubMed and the archives of the Morbidity and
Mortality Weekly Report (available at http://www.cdc.gov/
mmwr) to locate any published reports that described those
investigations, their findings, and the resulting recommendations.
Wherever possible, we determined, for each outbreak,
the causative agent; the location of the occurrence; whether
the outbreak involved single or multiple institutions or was
national or international in scope; whether the outbreak was
associated with use of an invasive device, procedure, or
contaminated product; and the public health implications.

细菌耐药

During 1946–2005, EISOs conducted a total of 531 onsite
investigations inmultiple health care settings across the United
States and abroad (Table 1). The international investigationswere performed in 33 facilities in 13 countries (Table 1).

细菌耐药

那表1是什么呢，我们来看一下：

细菌耐药

这张图的结果更直观，顺便直接贴出来给大家看看：

细菌耐药

分析到这儿了，我想大家也应该看出来了。正因为本研究调查了多个国家的情况，所以“受污染食品来源的国家分布”就很容易理解了。看来，老外没有犯错啊，不是笔误。

鬼才

细菌耐药 发表于 2012-2-27 03:27

                               
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分析到这儿了，我想大家也应该看出来了。正因为本研究调查了多个国家的情况，所以“受污染食品来源的国家分 ...

看了你的回复，说明我犯了一个原则性的错误：翻译文章一定要在认真阅读领会全文的基础上进行，否则很容易出现违背原文的翻译错误，这对我来说是一个教训，对专业文章的翻译一定要把握好“信、达、雅”的标准，不能仅根据每一句的直译而下绪论。谢谢你的指教。我相信这样的交流对于我们的学习是有提高的。总之，从这件事上可以看出，做学问一定要严谨，切记!

细菌耐药

鬼才 发表于 2012-2-27 09:33

                               
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看了你的回复，说明我犯了一个原则性的错误：翻译文章一定要在认真阅读领会全文的基础上进行，否则很容易 ...

鬼才版主言重啦，您在翻译时精益求精，反复核实，是值得我们学习的。有些人可能直接翻译结束了，而不会提出这个问题，那就没有这个结果了。

总之，通过交流，大家都能学习到新的知识，这才是最重要的。

yage

学习了，很好的资料。

二附院

非常好的医院感染暴发资料！