目前针对CRE接触隔离没有特别明确的要求，文件中都是原则上或者是推荐应该什么时候接触隔离，补充一些信息。美国CDC关于CRE接触隔离提出以下意见：
When can Contact Precautions be discontinued for patients colonized or infected with CRE?
There is currently not enough information for CDC to make a general recommendation on when isolation can be discontinued for patients colonized or infected with CRE. CRE colonization can be prolonged (> 6 months). Across multiple studies, predictors of prolonged CRE carriage have been found to include:
exposure to antibiotics
presence of an invasive device
higher Charlson’s co-morbidity scores
number of hospital admissions
admission from another facility
admission from or discharge to a long-term care facility [Schechner et al., 2011; Feldman et al., 2013; Zimmerman et al., 2013]
Presence of these predictors should be considered when deciding whether to discontinue Contact Precautions.
If considering discontinuing Contact Precautions based on the results of surveillance cultures, it is appropriate to wait for at least 3 to 6 months since last positive culture or screen. The decision to discontinue Contact Precautions for an individual with a history of colonization or infection with CRE should be made in consultation with public health. In general, failure to identify CRE from at least two sets of screening cultures are the minimum criteria that should be met before an episode of colonization is considered resolved. Additionally, retesting of the site(s) that were positive initially from clinical cultures is usually indicated, particularly non-sterile sites such as a wound or urine.
目前没有足够的信息使疾病预防控制中心就何时可以停止对CRE定殖或感染的患者进行隔离提出一般性建议。CRE定植可延长(> 6个月)。多项研究发现，CRE携带时间延长的预测因素包括:
接触抗生素
存在侵入性设备
更高的查尔森合并症评分
住院人数
从其他设施入院
长期护理机构的入院或出院[Schechner et al.， 2011;Feldman et al.， 2013;Zimmerman et al.， 2013]
在决定是否停止接触预防措施时，应考虑这些预测因素的存在。
如果根据监测培养结果考虑停止接触预防措施，则自上次阳性培养或筛查后至少等待3至6个月为宜。对于有CRE定殖史或感染史的个体，应在与公共卫生部门协商后决定停止接触预防措施。一般来说，至少两组筛选培养中未发现CRE是判定殖民化事件解决之前应满足的最低标准。此外，通常需要对最初临床培养呈阳性的部位进行重新检测，特别是伤口或尿液等非无菌部位。
总的来说，还需要更多的证据进一步探索应该何时解除隔离。
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发表于 2023-10-8 10:29
发表于 2023-10-8 10:43
