2007年ICAAC关于MRSA筛查的高级别辩论

icchina

我是全程参加了，是目前国际上关于MRSA筛查问题的最新和最高级别的辩论
希望好心的朋友翻译一下喔！
Interactive Symposium
MRSA Screening of High-Risk Populations and Healthcare Workers
Monday, 2:00 p.m. - 4:00 p.m.
E354A

Screening of ICU Patients: Pro or Con? Pro.
JEAN-CHRISTOPHE LUCET, MD, MPH.;
Bichat- Claude Bernard Hosp., Paris,, France.
Rates of MRSA are increasing in most ICUs worldwide, despite institution of contact precautions (CP) for patients carrying MRSA in clinical specimens, in addition to standard precautions (SP). The value of active surveillance cultures (ASC) at ICU admission is highly debated. ASC plus CP (ASCCP) have been successful in hospitals from north-European countries with sporadic MRSA cases. In an endemic setting, the evidence supporting ASCCP are the following : (1) ASC increased by 2-fold the proportion of MRSA carriers identified at ICU admission, compared to the yield of clinical specimens, (2) screening during ICU stay expedite the identification of MRSA carriage, (3) compliance with hand hygiene and gloving is higher in patients placed under CP than under SP, (4) most quasi-experimental studies concluded that ASCCP was effective, but few succeeded using SP only, (5) several authors, notably, observed that instituting CP, including alcoholic-handrub for hand hygiene, for patients with MRSA, were not effective, unless the whole MRSA reservoir was identified using ASC, (6) a recent comparative multicenter study comparing SP and ASCCP concluded that both strategies failed in controlling MRSA spreading, (7) ASCCP is cost-effective.
Whatever their extent, ASC should be part of a global strategy, in which compliance with standard precautions (for unrecognized MRSA carriers) and with CP (for identified MRSA carriers) probably remains critical. However, multicenter surveys indicated that few hospitals have implemented ASC. The efficacy of ASCCP may be higher in case of high MRSA prevalence at ICU admission or long ICU stay. Conclusions: Given the still low compliance with hand hygiene, ASCCP should be promoted. But ASC without high compliance with CP is worthless, and wastes time and money. The body of evidence supporting ASCCP remains to be demonstrated in well-conducted multicenter prospective studies. Whatever the strategy, a strong commitment and leadership probably are crucial for success.

icchina

Screening of ICU Patients: Pro or Con? Con.
ROBERT WEINSTEIN, MD.;
Cook County Hosp., Rush Med. Coll., Chicago, IL.
This is a pro-con debate about the value of screening patients at admission to ICUs for colonization with methicillin-resistant Staphylococcus aureus. Debators do not release their startegies or arguments before the time of the debate.

icchina

655
Screening of Healthcare Workers: Pro or Con? Pro.
ANDREAS VOSS, MD, PhD.;
CWZ & Radboud Univ. Med. Ctr., Nijmegen, The Netherlands.
Reasons why HCW screening is a necessity to effectively control the spread of MRSA - even is the absence of a RCT to proof it

David

RSA Screening of High-Risk Populations and Healthcare Workers(高危人群和医护人员MRSA的筛查)
Monday, 2:00 p.m. - 4:00 p.m.
E354A
Screening of ICU Patients: Pro or Con? Pro.（ICU病人的筛查：支持还是反对？支持）
JEAN-CHRISTOPHE LUCET, MD, MPH.;
Bichat- Claude Bernard Hosp., Paris,, France.
Rates of MRSA are increasing in most ICUs worldwide, despite institution of contact precautions (CP) for patients carrying MRSA in clinical specimens, in addition to standard precautions (SP). （尽管已经对携带有MRSA的病人采取接触预防的措施，加上实行标准预防的方法，但是在世界范围的重症监护病房内，MRSA的感染率仍在不断上升。）The value of active surveillance cultures (ASC) at ICU admission is highly debated.（在ICU实行主动监测培养ASC是否有其价值还在激烈的争论。） ASC plus CP (ASCCP) have been successful in hospitals from north-European countries with sporadic MRSA cases. （在北欧一些国家的医院，采取主动监测培养加上接触预防的方法控制MRSA获得了成功。那里只有散发的MRSA病例报告。）In an endemic setting, the evidence supporting ASCCP are the following :（在有MRSA流行的地方，采用ASCCP有以下优点。） (1) ASC increased by 2-fold the proportion of MRSA carriers identified at ICU admission, compared to the yield of clinical specimens, （与检测临床标本相比，ASC对ICU内MRSA携带者的检出率可以提高2倍。）(2) screening during ICU stay expedite the identification of MRSA carriage, （在住院期间筛查可以加快鉴别MRSA的携带情况。）(3) compliance with hand hygiene and gloving is higher in patients placed under CP than under SP, （病人在处在接触预防的情况下，手卫生的顺应性比在标准预防下更好。）(4) most quasi-experimental studies concluded that ASCCP was effective, but few succeeded using SP only, （大多数半经验性的研究都认为ASCCP是有效的，但仅仅使用标准预防却几乎没有成功的报道。）(5) several authors, notably, observed that instituting CP, including alcoholic-handrub for hand hygiene, for patients with MRSA, were not effective, unless the whole MRSA reservoir was identified using ASC,（值得i注意的是，一些研究者观察到，对携带有MRSA的病人采用接触预防的措施，包括用酒精擦手液进行手卫生消毒，并没有效果，除非采用ASC的方法将所有MRSA的贮存宿主都检测出来。） (6) a recent comparative multicenter study comparing SP and ASCCP concluded that both strategies failed in controlling MRSA spread ing,（一项最新的多中心ＳＰ和ＡＳＣＣＰ的比较研究得出一个结论，这两种方法都未能控制ＭＲＳＡ的蔓延扩散。） (7) ASCCP is cost-effective.（ＡＳＣＣＰ成本低，效益高。）
Whatever their extent, ASC should be part of a global strategy, in which compliance with standard precautions (for unrecognized MRSA carriers) and with CP (for identified MRSA carriers) probably remains critical. （无论二者的程度如何，ＡＳＣ应该作为全球策略的一部分。这种策略在于对未证实的ＭＲＳＡ携带者采取标准预防的措施，对已获证实的ＭＲＳＡ携带者采取接触预防的措施，两种预防的顺应性也许很重要。）However, multicenter surveys indicated that few hospitals have implemented ASC. （然而，多中心调查显示，很少的医院采取ＡＳＣ的措施。）The efficacy of ASCCP may be higher in case of high MRSA prevalence at ICU admission or long ICU stay.（假如在ＩＣＵ病房内ＭＲＳＡ高度流行或长期存在，ＡＳＣＣＰ可能更有效。） Conclusions: Given the still low compliance with hand hygiene, ASCCP should be promoted.（结论：如果手卫生的顺应性依然很差，ＡＳＣＣＰ就应该被推广。） But ASC without high compliance with CP is worthless, and wastes time and money. （但是，没有接触预防，单独采用主动监测培养的措施没有丝毫价值，还浪费时间和金钱。）The body of evidence supporting ASCCP remains to be demonstrated in well-conducted multicenter prospective studies. （上述这些支持ＡＳＣＣＰ的证据尚待精心设计的多中心回顾性研究予以阐明。）Whatever the strategy, a strong commitment and leadership probably are crucial for success.（无论什么策略，要想获得成功，一个强有力的委员会和领导者可能才是最重要的。）

David

creening of ICU Patients: Pro or Con? Con.（ICU病人的筛查：支持还是反对？反对）
ROBERT WEINSTEIN, MD.;
Cook County Hosp., Rush Med. Coll., Chicago, IL.
This is a pro-con debate about the value of screening patients at admission to ICUs for colonization with methicillin-resistant Staphylococcus aureus. （这是一个关于对ＩＣＵ内ＭＲＳＡ携带者进行筛查是否有价值得辩论。）Debators do not release their startegies or arguments before the time of the debate.（辩论者不要在辩论之前就说出自己的论点。）
Screening of Healthcare Workers: Pro or Con? Pro.（ICU病人的筛查：支持还是反对？支持）
ANDREAS VOSS, MD, PhD.;
CWZ & Radboud Univ. Med. Ctr., Nijmegen, The Netherlands.
Reasons why HCW screening is a necessity to effectively control the spread of MRSA - even is the absence of a RCT to proof it（为什么要对医护人员进行ＭＲＳＡ筛查的原因就是这样可以有效控制ＭＲＳＡ的蔓延，虽然现在还缺乏随机对照试验的证实。）