美国MRSA感染控制的变迁叙事

MRSA is now endemic in the United States with approximately 2% of the general population carrying the disease.在一个commentary published today inAntimicrobial Resistance & Infection Control,Dr.Kevin Kavanagh通过对导致这种情况的事件来讨论我们,并通过在美国入院时对MRSA进行普遍筛查来解决这一问题。医院。

A quote often attributed to Winston Churchill aptly observed"美国人总是可以被信任去做正确的事情,一旦所有其他的可能性都用尽了。”当观察我们的方法来控制MRSA时,这种观察从来就不那么真实。Through a series of policy iterations,美国似乎已经从MRSA发展成为一个严重的公共卫生问题,必须加以控制,一个我们没有控制,通常是"is no big deal".

包含MRSA爆发的时间检验策略是鉴定和分离携带者和感染者。As a young doctor in the 1980s I remember near panic and whole wards being closed due to an outbreak of MRSA.Then in the early 2000s the healthcare industry abandoned this standard using the lack of randomized controlled trials (RCTs) and conflicting studies,其中一些设计拙劣,as justification.

Arguably,这种弃置可能是由一个倡导病人测试和隔离的患者倡导运动推动的。因为它几乎不可能通过一项任务,直到它成为一个标准的护理。At least two peer-reviewed health policy manuscripts argued against MRSA surveillance and isolation as a first line intervention in conjunction with an argument against government mandates (,,2)In addition,美国的医疗保健系统正变得更加成本驱动,而携带者识别和隔离/非殖民化的策略代价高昂。

MRSA成为地方性疾病

After years of study and millions of dollars spent,我们发现了我们都应该知道的东西。It [decolonization] works.

But MRSA continued to be a problem and started to become endemic in the United States' population.Thestrategyof daily bathing with Chlorhexidine emerged.From the beginning it was controversial,通过一项数据解释受到质疑的研究推广被笼罩在表面上conflicts-of-interest.Finally,many of the same authorspublished a RCTwhich failed to demonstrate uniform efficacy on a facility-wide basis.

As the scientific community demanded more RCTs,美国浪费了10年的时间来控制MRSA,并成为了地方性疾病。RCTs were even funded to determine if MRSA carriers were at risk of infection and if decolonization would mitigate that risk.Adrian Voss以前expressed concernsregarding waiting to enact self-evident healthcare strategies until RCT are completed.After years of study and millions of dollars spent,我们发现了我们都应该知道的东西。它起作用了。

The epidemic of MRSA continued to progress,taking even deeper root in the community and residing in up to 5% of healthcare workers in the United States.Instead of confronting the epidemic head on and making large and needed resource investments,the narrative changed again,可以说是由A纽约时报OPED.MRSA carriage"is no big deal"公众几乎可以肯定的是,不必担心这一切。金宝搏娱乐城,指潜在致命的真菌和细菌。

这一观点似乎是由我的家乡肯塔基州的一些主要设施来证明他们在执行主动探测和隔离方面的不作为。And some of these facilities have the highest number of MRSA infections in the United States.但是在操作数据之后risk adjustment"这些设施被指定为“与国家基准没有什么不同.

A new direction is needed

病人倡导者现在从传染病当局听到了关于碳青霉烯类耐药的新叙述。肠杆菌科(CRE)和耳假丝酵母.我听到的最常见的论据是这些病原体通常在那些不处于高危状态的人中无害地存在。然而,I'm over 60,so I fall into this high-risk category and I do not think I want to take this chance.我觉得最好知道病人的微生物是什么,培养健康的微生物。without these pathogens.

The US has fallen victim to Group Think where many of our infectious disease authorities think the same and share a similar opinion,太害怕反响了,如果他们不同意。我们需要一个思维模式的转变。北欧的研究人员有不同的看法,and they have lower rates of MRSA infections.美国退伍军人健康管理局也在所有患者中对MRSA进行主动检测和隔离/非殖民化。They too report excellent rates of MRSA Control.

What is needed is a decisive realignment of healthcare resources to prevent spread of these dangerous pathogens to both patients and healthcare workers.

In the United States,transparency of infection rates is all but absent for dangerous pathogens leading to decreased accountability.This,combined with the lack of will to realign the necessary funds and the hope science will save us with newly developed,albeit short lived,抗生素,是美国无法控制耐药细菌的核心。

What is needed is a decisive realignment of healthcare resources to prevent spread of these dangerous pathogens to both patients and healthcare workers.抗生素的管理和抗生素的开发是很重要的,but neither of these interventions are likely to be effective in the short term.需要的是雇佣额外的传染病护士,an expansion of mandatory surveillance and isolation/decolonization strategies and implementation of a transparent and more comprehensive tracking system.

但最重要的是,we need to protect our healthcare workers who may well be acting as reservoirs to spread these pathogens to patients and their families.An economic safety net needs to be established and medical screening needs to take place.直到这些改革在美国的医疗设施中得到普遍实施,I have grave reservations that the epidemic of drug resistant bacteria will be brought under control.

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