耐碳青霉烯类鲍曼不动杆菌及耐碳青霉烯类肺炎克雷伯菌疑似医院感染暴发调查及防控效果评价  

Investigation on outbreak of nosocomial infection of suspected carbapenem-resistant acinetobacter baumannii and carbapenem-resistant klebsiella pneumoniae and evaluation of prevention and control effectiveness

作　　者：刘敏 余广超[2] 陶胜茹[1] 余浩辉[1] 佘文莉[1] 伍亚云 陈祖辉[3] LIU Min;YU Guangchao;TAO Shengru;YU Haohui;SHE Wenli;WU Yayun;Chen Zuhui(Department of Infection Control,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Clinical Laboratory,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Infection Control,the Fifth Affiliated Hospital of Jinan University,Heyuan 517000,China)

机构地区：[1]暨南大学附属第一医院感染控制科,广东广州510630 [2]暨南大学附属第一医院检验科,广东广州510630 [3]暨南大学附属第五医院感染控制科,广东河源517000

出　　处：《暨南大学学报（自然科学与医学版）》2021年第6期616-621,共6页Journal of Jinan University(Natural Science & Medicine Edition)

摘　　要：目的:调查耐碳青霉烯类鲍曼不动杆菌(CRAB)及耐碳青霉烯类肺炎克雷伯菌(CRKP)疑似医院感染暴发事件,评价控制措施实施效果.方法:通过现场流行病学调查和病原学检测方法,对2020年3月20日至3月27日暨南大学附属第一医院神经外科连续检出的CRAB感染患者3例、CRKP感染患者4例进行调查,并分析3~6月多重耐药菌患者医院感染发生率及CRAB、CRKP检出率.结果:3例CRAB及4例CRKP感染患者临床症状相似、耐药谱基本相同,属于疑似医院感染暴发.在神经外科病区床栏、床头柜及窗台环境标本中检测到鲍曼不动杆菌,在窗台检出肺炎克雷伯菌;采取防控措施后,4~6月医院感染发生率、多重耐药菌患者医院感染发生率及CRKP检出率均下降(χ^(2)=30.159,P<0.05;χ^(2)=30.101,P<0.05;χ^(2)=13.088,P<0.05).结论:此次CRAB、CRKP疑似医院感染暴发原因可能与病区内环境清洁消毒不规范、医务人员手卫生意识差、多重耐药菌感染患者院感防控措施落实不到位等因素有关,及时采取防控措施可有效控制疫情.Objective:To investigate the suspected outbreak of healthcare-associated infection caused by carbapenem-resistant acinetobacter baumannii(CRAB)and carbapenem-resistant klebsiella pneumoniae(CRKP)in hospital and to evaluate the control effect.Methods:Based on field investigations and pathogenic detection methods,an investigation was conducted on 3 CRAB-infected patients and 4 CRKP-infected patients continuously picked up in neurosurgery department from March 20,2020 to March 27,the incidence of multidrug-resistant bacterial infection in nosocomial patients and the detection rate of CRAB and CRKP were analyzed from March to June.Results:In neurosurgery department,3 patients with CRAB infection and 4 patients with CRKP infection were continuously detected within 8 days,the patients'drug resistance spectrum and clinical symptoms were similar,which was a suspected outbreak of nosocomial infection.acinetobacter baumannii(AB)can be detected from the bed bar,beside table and sill surface and klebsiella pneumoniae(KP)be discovered from the sill surface in neurosurgery department environmental samples.After taking prevention and control measures,the incidence of healthcare-associated infection,nosocomial infection of multi-drug resistant bacteria and the detection rate of CRKP were decreased significantly from March to June(χ^(2)=30.159,P<0.05;χ^(2)=30.101,P<0.05;χ^(2)=13.088,P<0.05).Conclusion:The cause of this suspected nosocomial infection outbreak in CRAB and CRKP may be related to inadequate environmental sanitation and disinfection in the ward,poor hand hygiene awareness of medical staff,and irregular nosocomial infection prevention and control management in the department.After take promptly and effective prevention and control measures,the development of the epidemic was controlled effectively.

关 键 词：耐碳青霉烯类鲍曼不动杆菌 耐碳青霉烯类肺炎克雷伯菌 医院感染 暴发 

分 类 号：R184[医药卫生—流行病学]