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ホームIMICライブラリMMWR抄訳2016年(Vol.65)バイタルサイン:病院における薬剤耐性菌感染症の防止・・・

MMWR抄訳

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2016/03/11Vol. 65 / No. 9

MMWR65(9):235-241
Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014

バイタルサイン:病院における薬剤耐性菌感染症の防止 ― アメリカ、2014年

医療関連感染(HAI)の中でもクロストリジウムディフィシル菌感染症(CDI)および6種の薬剤耐性菌(AR)感染症は、患者の罹患率および致死率を上昇させる公衆衛生上の脅威として特に重要である。CDCは全50州、ワシントンDCおよびプエルトリコからNational Healthcare Safety Network (NHSN)に報告されたデータを用い、主要なHAIである中心静脈カテーテル関連感染症(CLABSI)、尿道カテーテル関連感染症(CAUTI)および特定の手術部位感染症(SSI)について評価した。2014年、NHSNに報告されたHAIは、短期急性期病院約4,000施設からCLABSI:17,758例、CAUTI:35,760例、SSI:15,927例およびCDI:101,074例、長期急性期病院501施設からCLABSI:2,928例およびCAUTI:4,467例、入院リハビリテーション施設1,135施設からCAUTI:1,449例であった。各施設における標準化感染比を5~8年前のデータと比較した結果、CLABSIは短期および長期急性期病院においてそれぞれ50%および9%低下、CAUTIは短期、長期急性期病院および入院リハビリテーション施設においてそれぞれ0%、11%および14%低下、また、短期急性期病院においてSSIは17%、CDIは8%低下した。全施設において、CDIを除く79,021例のHAIのうち14.9%が1種類以上のARに関連していた。黄色ブドウ球菌感染症の47.9%がメチシリン耐性菌、腸球菌感染症の29.5%がバンコマイシン耐性菌、腸内細菌科菌群感染症の17.8%が基質特異性拡張型β産生菌、3.6%がカルバペネム耐性菌、緑膿菌感染症の15.9%、アシネトバクター感染症の52.6%が多剤耐性菌に起因した。医師、看護師および医療機関の責任者は、すべての推奨事項を継続的かつ包括的に遵守し、ARの拡散防止および適正な抗生物質使用によりカテーテルおよび手術関連HAIを防止する必要がある。

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