洋葱伯克霍尔德菌污染呋喃西林溶液致颅脑手术后颅内感染的病例分析  

Analysis of infection caused by furacillin solution contaminated with burkholderia cepacia after craniocerebral operation

作　　者：郑蜀芳 杨竹兰 张竹君 罗希 杨丽华 ZHENG Shu-fang;YANG Zhu-lan;ZHANG Zhu-jun;LUO Xi;YANG Li-hua(Department of Infection Control Section,First Affiliated Hospital,Army Medical University,Chongqing 400038,China;Department of Laboratory,First Affiliated Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院感染控制科,重庆400038 [2]陆军军医大学第一附属医院检验科,重庆400038

出　　处：《局解手术学杂志》2019年第12期1010-1014,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫计委项目(2018jstg022)

摘　　要：目的调查某院6例患者颅脑手术后洋葱伯克霍尔德菌(BC)污染呋喃西林溶液引起颅内感染病例,为预防和控制医院感染提供参考依据。方法回顾性分析某院2019年2月19日至3月21日6例颅脑手术后感染患者的临床资料,采用调查和现场采样检测相结合的方法,对患者所在环境物品表面细菌进行培养检测及菌种鉴定,对患者使用前后消毒剂以及痰液标本进行细菌培养,寻找颅脑手术后感染的原因。结果患者痰液中均培养出BC,感染患者在术后使用过呋喃西林溶液进行晨晚间口腔护理、伤口换药冲洗、腔道冲洗等。流行病学调查显示,环境物品表面、一次性注射器材、患者使用的液体、医护人员的手等经细菌学检测均合格,仅在6份使用中的呋喃西林溶液中培养出BC株,其药敏结果与患者痰液培养菌株一致。立即停止使用呋喃西林溶液进行口腔护理、伤口以及腔道冲洗,拔除患者深静脉置管,并行抗感染治疗。6例患者7 d后痰培养均无细菌生长,该病区再无相同病例出现。结论BC污染呋喃西林溶液是本次颅脑手术后感染暴发的原因,经积极采取措施,感染得到有效控制。Objective To investigate the cases of intracranial infection caused by furacillin solution contaminated with burkholderia cepacia(BC)in 6 patients after craniocerebral operation in a hospital,and to provide evidence for prevention and control of nosocomial infection.Methods The clinical data of 6 patients with infection after craniocerebral operation were analyzed retrospectively from February 19 to March 2019.In order to find the cause of infection after craniocerebral surgery,the method of investigation and field sampling and detection were used to culture and identify the bacteria on the surface of the articles in the environment where the patients lived,disinfectant before and after the use of patients,and sputum specimen of patients.Results BC was cultured in sputum specimen of patients after craniocerebral trauma surgery.After the operation,the infected patients used furacillin solution for morning and evening oral care,wound dressing change irrigation,cavity irrigation,etc.Epidemiological investigations showed that microbiological detection of the surface of environmental objects,disposable injection equipment,liquids used by patients,hands of medical staff were all qualified.BC was only cultured from 6 copies of furacillin solution in use,and the sensitivity results were consistent with the patients′sputum culture strain.Immediately stopped the use of furacillin solution for oral care,wound dressing change irrigation,and cavity irrigation,removed the deep vein catheterization,and anti-infection treatment were performed.No bacterial growth was observed in sputum culture of 6 patients after 7 days,and no similar cases were found in this area.Conclusion The BC-contaminated furacillin solution was the cause of the outbreak of infection after this craniocerebral operation.The infection was effectively controlled after active measures were taken.

关 键 词：洋葱伯克霍尔德菌 颅脑手术 颅内感染 医院感染 流行病学调查 呋喃西林 肺部感染 

分 类 号：R181.3[医药卫生—流行病学]