消化ICU耐碳青霉烯类肺炎克雷伯菌感染暴发调查与控制  

Investigation and control of infection outbreak of carbapenem-resistant Klebsiella pneumoniae in a gastroenterology intensive care unit

作　　者：廖睿纯 邓琼[2] 何思云 余奇[2] 徐珍[2] 周芸[2] 曹先伟[2] 庞水子 LIAO Rui-chun;DENG Qiong;HE Si-yun;YU Qi;XU Zhen;ZHOU Yun;CAO Xian-wei;PANG Shui-zi(Jiangxi Medical College, Nanchang University, Nanchang 330006, China;Department of Healthcare-associated Infection Management, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China;Department of Outpatient, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China;Gastroenterology Intensive Care Unit, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China)

机构地区：[1]南昌大学江西医学院,江西南昌330006 [2]南昌大学第一附属医院医院感染管理科,江西南昌330006 [3]南昌大学第一附属医院门诊部,江西南昌330006 [4]南昌大学第一附属医院消化ICU,江西南昌330006

出　　处：《中国感染控制杂志》2019年第2期111-114,共4页Chinese Journal of Infection Control

基　　金：江西省科技厅重点项目(20152ACG70015)

摘　　要：目的对消化重症监护病房(ICU)耐碳青霉烯类肺炎克雷伯菌(CRKP)感染暴发事件进行调查与控制,为临床多重耐药菌防控提供参考。方法对2018年1月21—31日某院消化ICU3例CRKP感染患者进行流行病学调查,按照环境生物学监测方法采集标本,查找环境中的CRKP,应用脉冲场凝胶电泳(PFGE)分析患者与环境分离菌株的同源性。结果 3例患者痰及血标本均检出CRKP,均为男性,床位相邻,均位于同一间病房内,且由同一医生经管。病区2018年1月CRKP检出数及感染率较其他月份升高,且感染率比较,差异有统计学意义(χ~2=13.67,P<0.01)。共采集空气、物体表面等环境标本102份,仅其中1份(护理人员工作服)检出1株肺炎克雷伯菌。对患者和环境分离的肺炎克雷伯菌进行PFGE分型,结果显示共有A、B两种基因型,护理人员工作服、07床患者腹腔积液与血标本、08床血标本、09床痰与血标本分离的肺炎克雷伯菌为A型,而07床痰标本检出的肺炎克雷伯菌属于B型,09床腹腔积液标本检出的肺炎克雷伯菌未能分型。采取综合干预措施后,3例患者未再检出CRKP,且病区内无新发病例。结论医务人员多重耐药菌预防控制措施执行不到位可能是此次CRKP传播的重要原因。Objective To investigate and control the outbreak of infection caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)in a gastroenterology intensive care unit(ICU),so as to provide reference for the prevention and control of clinical multidrug-resistant organisms(MDROs).Methods Epidemiological investigation was conducted on 3 patients with CRKP infection in a gastroenterology ICU on January 21-31,2018,specimens were collected with environmental biology monitoring method,CRKP in environment was searched,homology between patients and environmental isolates were analyzed by pulsed-field gel electrophoresis(PFGE).Results Three patients were all isolated CRKP from sputum and blood specimens,all were male,with adjacent beds in the same ward,and treated by the same doctor.The number of isolated CRKP and infection rate in January 2018 were higher than those in other months,infection rate was significantly different(χ^2=13.67,P<0.01).A total of 102 environmental specimens were collected,including air and surface of objects,only 1 of which(nurse’s uniform)was isolated 1 strain of KP.PFGE typing of KP isolated from patients and environment showed that there were two genotypes A and B,KP isolated from uniform of a nurse,hydrops abdominis and blood specimen of patient at bed 07,blood specimen of patient at bed 08,as well as sputum and blood specimen of patient at bed 09 were all type A,KP isolated from sputum specimen of patient at bed 07 was type B,KP isolated from hydrops abdominis in patient at bed 09 was not be typed.After comprehensive intervention,CRKP was not no longer isolated from 3 patients,and there was no new case in the ward.Conclusion Imperfect implementation of prevention and control measures for MDROs by health care workers may be an important cause for the spread of CRKP.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 医院感染 暴发 调查 控制 

分 类 号：R181.32[医药卫生—流行病学]