美国关于医院内多重耐药微生物预防控制标准的推荐指导意见

David

Infect Control Hosp Epidemiol 2008;29:901–913
© 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2910-0001$15.00
DOI: 10.1086/591741
SHEA/HICPAC Position Paper
Recommendations for Metrics for Multidrug-Resistant Organisms in Healthcare Settings: SHEA/HICPAC Position Paper
美国关于医院内多重耐药微生物预防控制标准的推荐指导意见
Adam L. Cohen, MD, MPH;
David Calfee, MD, MS;
Scott K. Fridkin, MD;
Susan S. Huang, MD, MPH;
John A. Jernigan, MD;
Ebbing Lautenbach, MD, MPH, MSCE;
Shannon Oriola, RN, CIC, COHN;
Keith M. Ramsey, MD;
Cassandra D. Salgado, MD, MS;
Robert A. Weinstein, MD; for the
Society for Healthcare Epidemiology of America and the Healthcare Infection Control Practices Advisory Committee

From the Divisions of Bacterial Diseases (A.L.C.) and Healthcare Quality Promotion (S.K.F.), Centers for Disease Control and Prevention, Atlanta, Georgia; the Department of Medicine, Mount Sinai School of Medicine, New York, New York (D.C.); the Division of Infectious Diseases, University of California Irvine Medical Center (S.S.H.), Orange, and Sharp Metropolitan Medical Campus (S.O.), San Diego, California; the Departments of Medicine and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania (E.L.); the Departments of Safety and Infection Control, Pitt County Memorial Hospital, and the Department of Medicine, The Brody School of Medicine at East Carolina University, Greenville, North Carolina (K.M.R.); Medical University of South Carolina, Charleston, South Carolina (C.D.S.); Cook County Bureau of Health Services and Rush Medical College, Chicago, Illinois (R.A.W.).

Received June 25, 2008; accepted July 3, 2008; electronically published September 9, 2008.

Address reprint requests to Adam L. Cohen, MD, MPH, Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-23, Atlanta, GA 30333 (dvj1@cdc.gov).
Executive SummaryMonitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and practical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of infection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in documenting trends over time within their facility and should not be used for interfacility comparison.

The following MDROs are addressed: (1) methicillin-resistant Staphylococcus aureus; (2) vancomycin-resistant Enterococcus species; (3) multidrug-resistant gram-negative bacilli; and (4) vancomycin-resistant S. aureus. We convened a working group of experts that reviewed current practices, the peer-reviewed literature, and existing guidelines on surveillance strategies and key metrics.

We propose that healthcare facilities use the following 4 routine metrics to monitor MDROs and the infections they cause: (1) an MDRO-specific line list for tracking patients who have acquired an MDRO; (2) an antibiogram for monitoring susceptibility patterns of isolates recovered from patients; (3) the incidence of hospital-onset MDRO bacteremia, which is an objective, laboratory-based metric that is highly associated with invasive disease and does not require chart review to estimate infection burden; and (4) clinical culture results, to measure incidence of infection or colonization, to quantify the number of people whose MDRO acquisition is healthcare associated. In addition, healthcare facilities may want to calculate both the overall prevalence of carriage and the prevalence of carriage at admission, the latter of which can be useful in detecting importation of methicillin-resistant S. aureus into healthcare facilities, to estimate the exposure burden. Active surveillance testing can augment and increase the accuracy of some metrics. Healthcare facilities not performing active surveillance testing might wish to consider point-prevalence screening, to help assess how much the number of positive clinical culture results underestimates the hidden reservoir of MDROs. It is important to understand the limitations of all proxy metrics. Because of the paucity of published research findings focused on this area of study, most recommendations were based on opinion and were heavily influenced by the perceived usefulness and simplicity of the metric for assessing MDROs in the hospital setting and for determining the impact of interventions.