神经外科患者艰难梭菌感染的临床护理及防控  

Clinical nursing and prevention of Clostridioides difficile infection in neurosurgical patients

作　　者：毕夏菁 杨芷[1] 赵平 童晓飞[1] Bi Xiajing;Yang Zhi;Zhao Ping;Tong Xiaofei(Department of Nursing,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310003)

机构地区：[1]浙江大学医学院附属第一医院护理部,杭州310003

出　　处：《中国抗生素杂志》2025年第2期144-151,共8页Chinese Journal of Antibiotics

摘　　要：目的 本研究探讨神经外科艰难梭菌的分子流行特征及在院内监测条件下,及时且严格落实院内防控和个人卫生措施在控制院内艰难梭菌交叉传播的实效性,以及临床护理对神经外科患者艰难梭菌感染预后的影响。方法 本单位自2011年1月开始进行艰难梭菌院内传播监测,其间发现神经外科病房出现艰难梭菌交叉传播,通过科室感控责任护士监督严格落实防控措施,加强临床护理,同时继续监测病房艰难梭菌流行;并将分离培养的艰难梭菌进行全基因组测序分析,了解监测不同时期艰难梭菌的基因特征。结果 本研究涵盖神经外科3个楼层的病房(病房一、病房二和病房三)住院腹泻患者,共计分离得12株艰难梭菌,主要为ST35和ST37,分离率为10.9%(12/110)。在监测前期,通过PCR-核糖体分型发现不同楼层的菌株之间存在同源性。在院感科督查下,由感控责任护士规范化严格落实消毒隔离措施,并对艰难梭菌患者加强临床护理,在后续监测过程中未发现艰难梭菌的交叉流行。通过对分离到的艰难梭菌全基因组数据分析,发现交叉传播菌株属于携带多重耐药基因的ST-37型艰难梭菌。结论 加强临床抗菌药物的合理使用,严格落实院内防控和个人卫生措施是减少院内传播和实现医院感染控制至关重要的措施。同时,精细化的临床护理能改善神经外科艰难梭菌感染患者预后。Objective To investigate the molecular epidemiology of Clostridioides difficile(C.difficile)in the neurosurgery department and the effectiveness of timely and strict implementation of nosocomial prevention and control measures and personal hygiene practices in controlling C.difficile cross-transmission under surveillance and to determine the impact of clinical care on the prognosis of neurosurgical patients with C.difficile infection.Methods Since January 2011,surveillance of the nosocomial transmission of C.difficile has been implemented in our hospital.During this period,a cross-transmission of C.difficile in neurosurgery wards was identified.The rigorous preventive and control measures were implemented by the infection control nurses,as well as improvements to the clinical care.Furthermore,whole-genome sequencing analysis of C.difficile was conducted to investigate the genetic characteristics of C.difficile in different surveillance periods.Results This study encompassed inpatients with diarrhea in three different neurosurgery wards(Ward 1,Ward 2 and Ward 3).A total of 12 strains of C.difficile were isolated,with an isolation rate of 10.9%(12/110).Among them,ST35 and ST37 were the dominant types.The strains from different wards were homologous identified by PCR-ribosomal type during the pre-monitoring period.In accordance with the supervision of hospital infection-control department,the infection control nurses strictly adhered to implement standardized disinfection and isolation measures,and improved the clinical care for patients.No cross-transmitted strains of C.difficile was not detected during the follow-up surveillance.The whole genome data of the isolated C.difficile strains revealed that the cross-transmitted strains belonged to ST-37,which carried multi-drug resistance genes.Conclusion Strengthening the rational use of clinical antimicrobial drugs,the implementation of rigorous nosocomial prevention,and personal hygiene measures are crucial measures to reduce nosocomial transmission and attain optimal

关 键 词：艰难梭菌感染 艰难梭菌 神经外科 临床护理 隔离防控 

分 类 号：R978.1[医药卫生—药品]