血液科病房碳青霉烯类耐药肺炎克雷伯菌感染的调查与干预  

Prevalence of carbapenem-resistant Klebsiella pneumoniae infections in wards of hematology department and control interventions

作　　者：同俏静[1] 赵晋[1] 陈冬容 王海萍[2] 赵锋[3] 俞云松[4] 

机构地区：[1]浙江大学医学院附属邵逸夫医院医院感染管理科,浙江杭州310016 [2]浙江大学医学院附属邵逸夫医院医院中心实验室,浙江杭州310016 [3]浙江大学医学院附属邵逸夫医院医院检验科,浙江杭州310016 [4]浙江大学医学院附属邵逸夫医院医院感染性疾病科,浙江杭州310016

出　　处：《中华医院感染学杂志》2017年第16期3651-3654,共4页Chinese Journal of Nosocomiology

摘　　要：目的通过对血液科病房碳青霉烯类耐药肺炎克雷伯菌(CRKP)致3例血流感染病例的调查及感控干预,为预防医院感染暴发流行提供参考依据。方法 2013年6月事件发生期间设定为A组107例,2013年7月-12月设置为B组629例,2014年设置为C组1 081例,2015年设置为D组1 161例;对2013年6月3例CRKP致血流感染的患者进行临床及分子流行病学调查分析,并采取消毒隔离等干预措施,根据事件发生期、干预后分组并追踪30个月,运用χ~2检验分析不同组间感染发生率差异。结果 3例菌株属同一基因克隆,经启动消毒隔离等干预措施,观察干预后仅发生1例CRKP新病例,事件发生期、干预后CRKP感染率差异有统计学意义(P<0.05),无暴发流行事件。结论接触传播是此次事件的主要疑似因素;落实接触隔离措施、提高医护人员手卫生依从性、严格执行无菌操作、加强环境及物体表面的清洁与消毒、强化终末消毒,将有效预防医院感染的发生。OBJECTIVE To investigate 3 cases of bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae （CRKP） in wards of hematology department and put forward the control interventions so as to provide guidance for prevention of outbreak and prevalence of nosocomial infections.METHODS Totally 107 patients who had the CRKP bloodstream infections in Jun 2013 were assigned as the group A, 629 patients who had the infections from Jul 2013 to Dec 2013 were assigned as the group B, 1 081 patients who had the infections in 2014 were assigned as the group C, and 1 161 patients who had the infections in 2015 were assigned as the group D.The clinical and molecular epidemiological survey was conducted for the 3 patients with bloodstream infections caused by CRKP, the intervention measures such as disinfection and isolation were taken, the patients were tracked for 30 months according to the periods of emergence of incident and after the intervention, and the incidence of infections was analyzed by means of chi-square test.RESULTS The 3 CRKP isolates belonged to the gene clone, and only 1 patient had the CRKP bloodstream infection after the intervention measures such as disinfection and isolation were taken, and there was significant difference in the incidence rate of CRKP infections in the periods of emergence of incident and after the intervention （P〈0.05）, and no epidemic outbreak occurred.CONCLUSION The contact spread is the leading suspected factor for the incident.It is an effective way to implement the contact isolation measures, improve the health hygiene compliance of the health care workers, rigidly execute the aseptic operation, strengthen the cleaning and disinfection of environment and object surfaces, and intensify the terminal disinfection so as to prevent the nosocomial infections.

关 键 词：碳青霉烯类耐药肺炎克雷伯菌 血流感染 医院获得性感染 

分 类 号：R378.996[医药卫生—病原生物学]