akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

成人のMRSA感染制御

勝手にMRSA復習週間

守りの感染は知識不足と認識してます。
一般常識まで引き上げたいです。
せめて、Antibiotic stewardshipの貢献は頑張ります。


UpToDate より引用

Basic infection prevention principles include attention to careful hand hygiene and adherence to contact precautions for care of patients with known MRSA infection.

Active surveillance cultures identify asymptomatic individuals with MRSA colonization to be placed on contact precautions with the goal of minimizing MRSA spread to other patients. This practice is appropriate in the setting of an outbreak; its role for routine screening is a question of ongoing debate. 

We suggest that decolonization not be performed in the routine management of MRSA infections (Grade 2B). Decolonization does not appear to be consistently effective for eliminating MRSA carriage, and emergence of resistance to agents used for decolonization will limit the utility of such protocols. 

We suggest performing decolonization in the setting of a MRSA outbreak, particularly if there is epidemiologic evidence pointing to transmission by one or more healthcare workers or among individuals in a specific population (Grade 2C). Regimens are outlined above.

Additional important components for MRSA prevention and control include environmental cleaning and prudent antibiotic use. 

Tools for preventing MRSA spread in the community include hand hygiene and minimizing risk factors for transmission. Decolonization may be appropriate if there is epidemiologic evidence pointing to transmission within a household.

Antibiotic stewardship

 Inappropriate or excessive antibiotic use can lead to selection of resistant organisms.The risk of MRSA colonization has been correlated with the frequency and duration of prior antimicrobial therapy.Several studies have documented a higher risk of MRSA colonization following therapy with fluoroquinolones in particular.
Reductions in the use of certain antibiotics can reduce the incidence of MRSA infection .However, altering an antibiotic formulary can in turn lead to emergence of other resistant pathogens.