1起ICU疑似耐碳青霉烯类肺炎克雷伯菌医院感染暴发的调查处置  

Investigation and disposal of a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae nosocomial infection in intensive care unit

作　　者：吴清梦 赵俊 喻娇 刘欢 金宗英 WU Qingmeng;ZHAO Jun;YU Jiao;LIU Huan;JIN Zongying(The Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]西南医科大学附属中医医院,四川泸州646000

出　　处：《预防医学情报杂志》2024年第3期255-259,共5页Journal of Preventive Medicine Information

基　　金：西南医科大学-附属中医医院联合项目(项目编号:2020XYLH-086)。

摘　　要：目的调查分析某院1起重症监护病房(ICU)疑似耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发事件,为多重耐药菌引起的院内感染暴发防控提供依据。方法对2019年12月30日至2020年1月14日泸州市某医院ICU检出7例CRKP患者事件进行现场流行病学调查处置,使用SAS 9.4对结果进行统计分析,以P<0.05为差异有统计学意义。结果该病房发生的7例CRKP患者当中,有4例判断为医院感染病例。对7例CRKP患者所在科室的高频接触物体表面、在院患者手表面、病区工作人员手表面、床扶手、床沿、床头柜、呼吸机面板及导管内径、气管导管口外缘、心电监护仪按键、工作区电脑键盘等采集80份标本,其中环境物体表面标本65份、手表面标本15份,1份患者(ICU 7床)手表面标本检出CRKP(检出率为1.25%),其余标本均未检出CRKP。采取隔离、病区清洁消毒等措施后随访监测近2个月未再出现新发CRKP医院感染病例。结论本次疑似CRKP医院感染暴发是由于未对CRKP感染患者采取集中隔离措施,病原体污染环境引起。Objective To investigate and analyze an outbreak of suspected carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in the intensive care unit(ICU)of a hospital,and to provide evidence for the prevention and control of nosocomial infection outbreak caused by multi-drug resistant bacteria.Methods From December 30,2019 to January 14,2020,an on-site epidemiological investigation was conducted on the 7 CRKP patients detected by the ICU of the hospital in Luzhou City.SAS 9.4 was used to statistically analyze the results,and P<0.05 was considered to be statistically significant.Results Among the 7 CRKP patients in this ward,4 were judged to be nosocomial infection cases.A total of 80 specimens were collected,such as surfaces of highfrequency contact objects in the department of 7 patients with CRKP,hand surfaces of patients in the hospital,hand surfaces of ward staff,bed handrails,bed edges,bedside tables,ventilator panel and inner diameter of catheter,outer edge of tracheal catheter mouth,button of electrocardiogram monitor and computer keyboard of working areas.Among them,65 surface specimens of environmental objects,15 hand surface specimens and 1 hand surface specimen of a patient(bed 7 in ICU)were detected with CRKP,with a detection rate of 1.25%.And no CRKP was detected in the other specimens.After measures such as isolation and ward cleaning and disinfection were conducted,there was no new CRKP nosocomial infection case in nearly 2 months of follow-up and monitoring.Conclusions This outbreak of suspected CRKP nosocomial infection was caused by the pathogen contamination of the environment without centralized isolation measures for CRKP infected patients.

关 键 词：重症监护病房 耐碳青霉烯类肺炎克雷伯菌 医院感染 暴发 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]