神经内科ICU耐碳青霉烯鲍氏不动杆菌感染调查与控制  

Epidemiological investigation and control of carbapenem-resistant Acinetobacter baumannii infections in neurology department ICU

作　　者：邓琼[1] 周芸[1] 徐珍[1] 余奇[1] 饶思友[1] 唐素琴[1] 曾凌 曹先伟[1] 

机构地区：[1]南昌大学第一附属医院医院感染管理科,江西南昌330006

出　　处：《中华医院感染学杂志》2017年第18期4102-4105,共4页Chinese Journal of Nosocomiology

基　　金：江西省科技厅重点基金资助项目(20152ACG70015)

摘　　要：目的对神经内科ICU患者耐碳青霉烯鲍氏不动杆菌感染事件进行调查与控制,为临床多药耐药菌预防控制提供参考。方法对2017年2月27日-2017年3月10日神经内科ICU 4例耐碳青霉烯鲍氏不动杆菌感染患者进行流行病学调查,采用环境生物学监测方法采集标本124份,其中空气21份,物体表面87份,医务人员手部6份、鼻腔6份、工作服4份,查找环境中的鲍氏不动杆菌,Eric(肠杆菌基因间重复共有序列)-PCR和多位点序列分型(MLST)分析患者分离的菌株与环境中菌株的同源性。结果 Eric-PCR和MLST结果显示4名患者的痰液标本中检出2种基因型鲍氏不动杆菌,分别为ST92型和ST75型,其中1床和12床患者临床菌株具有同源性,09床和19床患者临床菌株具有同源性;6份物体表面标本检出鲍氏不动杆菌,分别为鼻饲碗、床沿、护理人员工作服,其中12床鼻饲碗,09、19床床沿,护理人员工作服上检出的鲍氏不动杆菌与12床患者痰液标本中的鲍氏不动杆菌属于同一基因型。结论环境物体表面的消毒、手卫生和隔离措施的缺失是此次多药耐药菌传播的环节,在多药耐药菌患者的诊疗过程中应当重视消毒隔离措施的执行。OBJECTIVE To investigate the prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）infections in neurology department ICU so as to provide guidance for clinical prevention and control of multidrug-resistant organisms.METHODS The epidemiological survey was conducted for 4 patients with CRAB infection were treated in the neurology department ICU from Feb 27,2017 to Mar 10,2017,totally 124 specimens were collected by using environmental biology monitoring method,including 21 air specimens,87 object surface specimens,6 specimens from health care workers′hands,6 specimens from nasal cavity,and 4 specimens from work clothes.The environmental A.baumannii strains were detected.The homology between the isolated strains from the patients and the environmental strains was analyzed by means of enterobacterial repetitive intergenic consensus sequence（Eric）-PCR and multilocus sequence typing（MLST）.RESULTS The results of Eric-PCR and MLST showed that the A.baumannii strains that carried with two genotypes（ST92 and ST75）were isolated from sputum specimens of 4 patients,the strains isolated from bed 1 patient and the strains isolated from bed 12 patient had the homology;the strains isolated from 09 bed patient and the strains isolated from bed 12 patient had the homology.The A.baumannii strains were isolated from 6 object surface specimens,which were nasal feeding bowls,bedsides and work clothes of staff,including the nasal feeding bowls and bedsides of bed 09 and 19.The A.baumannii strains isolated from the staff′s work clothes and strains isolated from sputum specimens of bed 12 patient had the same genotype.CONCLUSIONThe lack of disinfection of environmental object surfaces,hand hygiene or isolation measures is the cause of spread of multidrug-resistant organisms.It is necessary to focus on the implementation of the disinfection and isolation measures during the diagnosis and treatment of the patients with multidrug-resistant organisms infections.

关 键 词：耐碳青霉烯鲍氏不动杆菌 暴发 调查 控制 

分 类 号：R378[医药卫生—病原生物学]