美国MRSA感染控制的变化叙事

MRSA现在在美国流行,大约2%的普通人患病。在一个今天发表的评论抗微生物抗性和感染控制,凯文·卡文纳博士会谈我们通过t的事件hat led to this situation and makes the case for combatting the issue through universal screening of MRSA on admission to U.S. hospitals.

一旦所有其他可能性都疲惫不堪,常常归因于Winston Churchill的报价常常归因于Winston Churchill ached“美国人总是值得信任。”当一个人看着我们对MRSA的控制的方法看法,这一观察从来都不是勇者。通过一系列政策迭代,美国似乎已经从MRSA成为一个严重的公共卫生问题,这是必须控制的,我们没有控制,通常是它“没什么大不了的”。

The time-tested strategy for containing an MRSA outbreak was identification and isolation of carriers and those infected. 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, some of which were poorly designed, as justification.

可以说,这种遗弃可能已经被患者倡导运动来授权测试和隔离,因为几乎不可能通过任务,直到它已成为护理标准。至少有两个同行评审的健康政策手稿争论MRSA监测和孤立,作为第一线干预,与政府任务的争论相结合(1,2). In addition, the United States healthcare system was becoming more cost driven and the strategy of carrier identification and isolation/decolonization was a costly one.

MRSA成为地方性

经过多年的学习和数百万美元的花费,我们发现了我们所有人都应该知道的。It [decolonization] works.

But MRSA continued to be a problem and started to become endemic in the United States’ population. The战略用氯己定日常沐浴出现。从开始,它是有争议的,被一项研究所讨论的研究,并笼罩在明显conflicts-of-interest。最后,许多同样的作者published a RCT未能以设施为基础展示均匀效果。

As the scientific community demanded more RCTs, the United States wasted a decade in controlling MRSA and it became endemic. RCTs were even funded to determine if MRSA carriers were at risk of infection and if decolonization would mitigate that risk. Adrian Voss has previouslyexpressed concerns关于等待在RCT完成之前等待不言而喻的医疗策略。经过多年的学习和数百万美元的花费,我们发现了我们所有人都应该知道的。有用。

MRSA的流行病继续取得进步,在社区中更深层次的根源,居住在美国高达5%的医疗保健工作者。叙述再次改变了叙述,而不是面对疫情的头脑,而不是面对疫情的头脑,而是让叙述再次变化New York Times OpEd。MRSA.carriage “is no big deal” and the public “almost certainly [does] not need to worry about any of this”, referring to potentially deadly fungi and bacteria.

This view appears to be held by some of the major facilities in my home state of Kentucky to justify their inaction in performing active detection and isolation. And some of these facilities have the highest number of MRSA infections in the United States. But after manipulating the data for “risk adjustment” the facilities are designated “no different from national benchmark”.

需要一个新的方向

患者倡导者现在已经听到了来自传染病当局的新叙述,有关Carbapenem的抗性enterobacteriaceae.(CRE)和candida auris。The most frequent argument I hear is that these pathogens usually reside harmlessly in those who are not at high risk. However, I’m over 60, so I fall into this high-risk category and I do not think I want to take this chance. I feel it is far better to know what a patient’s microbiome is and to foster a healthy one, without these pathogens.

美国堕落的受害者认为我们的许多传染病当局认为同样并分享类似的意见,如果他们不同意,这太害怕了反响。我们需要在我们的思想中转移范式。北欧的研究人员不同地思考不同的MRSA感染率较低。美国的退伍军人健康管理局也是在所有录取的患者上对MRSA进行主动检测和隔离/脱殖的卫生管理。他们也提出了卓越的MRSA控制费率。

所需要的是对医疗资源的决定性重新调整,以防止这些危险病原体传播给患者和医疗保健工人。

在美国,感染率的透明度均为危险的病原体缺席,导致责任下降。这加上缺乏将必要的基金和希望科学重新设计的缺乏将拯救我们,尽管短暂的抗生素,抗生素是在美国无法控制毒性细菌的核心。

所需要的是对医疗资源的决定性重新调整,以防止这些危险病原体传播给患者和医疗保健工人。抗生素管道和抗生素发展很重要,但这些干预措施都不在短期内有效。所需要的是雇用额外传染病护士的承诺,扩大强制监测和隔离/脱殖主义战略以及透明,更全面的跟踪系统的实施。

But of utmost importance, 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. Until these reforms are universally enacted in the United States Healthcare facilities, I have grave reservations that the epidemic of drug resistant bacteria will be brought under control.

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