多剤耐性菌感染症の施設内感染対策

Measures for the prevention of hospital-acquired infections with multiple-drug-resistant bacteria

薬剤耐性菌による感染症は治療に難渋する場合が多く，患者の予後を不良とし，入院期間の延長や医療費の増加を招く．また医療職員の手や汚染された器具，環境などを介して感染が伝播拡大し，時にアウトブレイクを引き起こすこともある．耐性菌を“作らない”ためにはantibiotic heterogeneity(抗菌薬の使い分け)によるantibiotic pressure control(抗菌薬選択圧のコントロール)が重要であり，また“拡げない”ためには，耐性菌検出時の日常的な対応ならびにアウトブレイクの早期発見のためのシステム化など多岐にわたる対策が必要である．本稿では，筆者らが実施している耐性菌対策の実際を述べた．

It is often difficult to treat patients with infections due to multiple-drug-resistant bacteria.　These infections are associated with a poor prognosis and long-term hospitalization, which increases medical expenditure.　The spread or even outbreak of infections may be caused through the hands of medical staff or contaminated instruments and environments.　To "avoid producing" multiple-drug-resistant bacteria, it is important to control the selective pressure based on antibiotic heterogeneity.　To "prevent the spread of infections", a wide variety of measures for the detection of bacteria in daily clinical practice and the development of a system to identify an outbreak at an early stage are essential.　The present paper reports the measures for the prevention of the growth of multiple-drug-resistant bacteria implemented in this hospital.