ICU一起疑似泛耐药鲍氏不动杆菌暴发调查与控制  

Investigation and control of the outbreak of suspected pan-drug resistant Acinetobacter Baumannii infection in ICU

作　　者：陈元宾 刘运喜[1] 闫中强[2] 陈威[3] 王沙沙[3] 匡慧慧 施施 朱乔[5] 许玉冰 杨金燕[1] 夏婷婷 屈佩玲 CHEN Yuan-bin;LIU Yun-xi;YAN Zhong-qiang;CHEN Wei;WANG Sha-sha;KUANG Hui-hui;SHI Shi;ZHU Qiao;XU Yu-bing;YANG Jin-yan;XIA Ting-ting;QU Pei-ling(Hainan Hospital of PLA General Hospital, Sanya , Hainan 572013 , China)

机构地区：[1]解放军总医院海南医院感染管理与疾病控制科,海南三亚572013 [2]解放军总医院第二医学中心,北京海淀100080 [3]解放军总医院海南医院重症医学科,海南三亚572013 [4]解放军总医院海南医院检验中心,海南三亚572013 [5]解放军总医院海南医院中心实验室,海南三亚572013

出　　处：《中华医院感染学杂志》2019年第8期1255-1261,共7页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划基金资助项目(2017YFC0806308);全军"十二五"科技重点基金资助项目(BWS13J027)

摘　　要：目的通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施。方法通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验。患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析。结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14%;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型。结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制。OBJECTIVE To investigate the outbreak of suspected pan-drug resistant Acinetobacter baumannii (PDR-AB) infection in ICU, and to study the cluster-based strategy for preventation and control of pandrug resistant A baumannii nosocomial infection, so as to guide the implementation of preventation and control measures for nosocomial infections. METHODS We conducted the survey by means of molecular epidemiological analysis combined with environmental hygiene monitoring to collect more information about the isolation and infection of PDRAB in ICU from Feb. to Apr. 2018. Environmental microorganism sampler was used to collect samples from the environment and items with suspected contamination for identification and drug sensitivity test.The homology of strains isolated from the patients and environment were studied using PFGE technique. RESULTS In Mar. 2018, there were 7 cases of A baumannii infection or colonization in ICU, with the new infection rate of 10.14%. PDRAB were isolated from the head cushion towel, bed tail plate and bed bar of patients with PDR-AB colonization or infection, table top of nurse station, care clothing of the medical staff and the bronchofiberscope after cleaning and disinfection. Drug sensitivity test showed that the resistance spectra of the 27 strains of PDR-AB isolated from ICU patients and the environment were basically the same, and the PFGE results revealed that the PDR-AB strains isolated from the patients, environment and bronchofiberscope belonged to the same subtype. CONCLUSION The cloned strains of PDR AB are highly homologous to each other among patients , the environment and bronchofiberscope. The outbreak situation can be effectively controlled by strengthening the aseptic concept of clinical medical and nursing staff, isolation of patients, strict cleaning and disinfection of the environment and medical equipment.

关 键 词：ICU PDR-AB 分子流行病学分析 环境卫生学监测 克隆传播 

分 类 号：R181.3[医药卫生—流行病学]