某监护室4例耳假丝酵母感染治疗与防控实践  

Experience in treatment,prevention and control of cases of Candida auris infection in an intensive care unit

作　　者：赵永生[1] 寇佳琪 赵庆华[1] 韩旭元 何蕾[1] 任为正[1] ZHAO Yong-sheng;KOU Jia-qi;ZHAO Qing-hua;HAN Xu-yuan;HE Lei;REN Wei-zheng(The First Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部重症医学科,北京100039

出　　处：《中华医院感染学杂志》2024年第18期2832-2837,共6页Chinese Journal of Nosocomiology

基　　金：科技部重点研发专项(2022XAGG0146)。

摘　　要：目的调查某监护室耳假丝酵母感染的交叉传播,评价感染防控的有效性。方法分析2023年1月-2023年6月某三甲医院耳假丝酵母疫情的临床治疗、病例时空关系和应急处置,并综合既往报道。结果2023年1月-2023年6月医院发生两条独立传播链的跨度5个月的耳假丝酵母疫情,全部患者均有多种细菌感染,包括碳青霉烯耐药菌感染,其中3例同时存在耐碳青霉烯类鲍氏不动杆菌(CRAB)和耐碳青霉烯类肺炎克雷伯菌(CRKP)感染,通过采取积极有效的适当隔离措施、使用专用消毒湿巾给与患者进行去定植处理、积极的环境及物体表面消毒、主动筛查及环境监测等措施,同时结合有效合理抗生素(包括碳青霉烯类、头孢菌素类及粘菌素等)控制细菌感染。抗真菌感染使用两性霉素B、氟康唑、伏立康唑、卡泊芬净等治疗。经过上述防控及治疗措施院内耳假丝酵母交叉传播感染共3例,未引起感染暴发,并未发生耳假丝酵母相关死亡病例。结论重症监护病房耳假丝酵母感染经过积极感染防控和合理治疗是可以有效控制耳假丝酵母的播散和蔓延。OBJECTIVE To investigate the cross transmission of Candida auris infection in an intensive care unit and evaluate the effectiveness of prevention and control of the infection.METHODS From Jan 2023 to Jun 2023,the clinical treatment,spatiotemporal relationship of the cases and emergency response to the C.auris epidemic in a tertiary hospital were observed,and the previous reports were comprehensively reviewed.RESULTS Two independent transmission chains of C.auris epidemic spanning 5 months from Jan 2023 to Jun 2023 were investigated,all of the patients had multiples types of bacterial infections,including carbapenem-resistant bacteria infection;3 cases had concurrent infections of carbapenem-resistant Acinetobacter baumannii(CRAB)and carbapenem-resistant Klebsiella pneumoniae(CRKP).The effective and appropriate isolation measures were taken,appropriative wet tissues of disinfection were used for decolonization,active disinfection of environment and object surfaces,active screening and environmental surveillance were carried out,meanwhile,the antibiotics including carbapenems,cephalosporins and colistin were effectively and reasonably used for control of bacterial infection.The cases of fungal infection were treated with amphotericin B,fluconazole,voriconazole and caspofungin.After the above prevention,control and treatment measures were taken,there were only 3 cases of cross transmission of C.auris infection in the hospital,no outbreak of infection and no death case related to C.auris.CONCLUSION The active prevention and control as well as reasonable treatment of ICU patients with C.auris infection can effectively control the transmission of the C.auris.

关 键 词：耳假丝酵母感染 院内感染 重症监护病房 重症急性胰腺炎 防控实践 流行病学 

分 类 号：R379.4[医药卫生—病原生物学]