某院新生儿重症监护病房一起CRKP医院感染暴发的流行病学调查  

Epidemiology of CRKP Infection Outbreak in a Neonatal Intensive Care Unit

作　　者：李伟杰[1] 陈丽琴 李亚玲[1] 韩永慧 李小娟[1] 王若谷[1] LI Weijie;CHEN Liqin;LI Yaling;HAN Yonghui;LI Xiaojuan;WANG Ruogu(Infection Management Department,Kunming Children's Hospital,Kunming Yunnan 650228,China)

机构地区：[1]昆明市儿童医院感染管理科,云南昆明650228

出　　处：《昆明医科大学学报》2023年第12期144-149,共6页Journal of Kunming Medical University

基　　金：昆明市卫生健康委卫生科研课题基金资助项目(2022-14-05-002)。

摘　　要：目的分析某医院新生儿重症监护病房(NICU)一起耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发的流行病学特征,探究可能引起暴发的因素。方法采用病例分析、流行病学调查、环境检测相结合的方法调查2022年3月11日至2022年5月3日某医院NICU住院患者检出CRKP情况,分析原因并采取相应的预防控制措施。结果此次NICU的CRKP暴发分2阶段,第1阶段从2022年3月11日至2022年3月30日,此阶段发生3例CRKP的医院感染;第2阶段为4月13日至5月3日,此阶段发生4例CRKP的医院感染。此次医院感染暴发事件的感染源为1号患者,13例CRKP的药敏均仅对阿米卡星和替加环素敏感、对左氧氟沙星中介、对其他抗菌药物高度耐药,13例CRKP均为产金属酶的耐药基因;发现暴发事件后,对病区环境采样共3次,共采35份标本,有14份检出CRKP,经过严格的环境清洁消毒与多举措的防控措施,至2022年5月13日后再未检出类似新发医院感染病例。结论此次NICU医院感染暴发可能是因为病区环境表面、医疗设备被污染、医务人员手卫生不到位引起的传播。故对环境表面严格的清洁消毒、加强医务人员手卫生及多举措并施,可有效控制CRKP的医院感染。Objective To analyze the epidemiological characteristics of an outbreak of carbapenem resistant Klebsiella pneumoniae(CRKP)hospital infection in the neonatal intensive care unit(NICU),and to explore possible causes of the outbreak.Methods Case analysis,epidemiological studies and environmental detection methods were used to investigate the detection of CRKP in the NICU of a hospital from March 11,2022 to May 3,2022,and the causes and corresponding prevention and control measures were analyzed.Results This CRKP outbreak in the NICU occurred in two phases.The first phase was from March 11,2022,to March 30,2022,during which 3 people contracted CRKP hospital infections.The second phase was from April 13,2022,to May 3,2022,during which 4 people contracted CRKP hospital infections.The source of the hospital infection outbreak was patient No.1.All 13 CRKP cases showed sensitivity only to amikacin and tigecycline,with intermediate sensitivity to levofloxacin,and high resistance to other antibiotics.All 13 CRKP cases carried resistant genes for metalloenzymes.After the outbreak,the ward environment was sampled three times,with 35 samples taken in total,and 14 of them tested positive for CRKP.After strict environmental cleaning,disinfection,and multiple control measures,no new hospital infection cases similar to this outbreak were detected after May 13,2022.Conclusion The outbreak of NICU hospital infections may be due to the contamination of the ward environment,medical equipment,and inadequate hand hygiene of medical staff,leading to its spread.Therefore,strict cleaning and disinfection of the environmental surfaces,strengthening hand hygiene of medical staff,and implementing multiple measures can effectively control hospital infections of CRKP.

关 键 词：CRKP 医院感染 新生儿 医院感染暴发 流行病学 

分 类 号：R183.7[医药卫生—流行病学]