山东省某医院1起碳青霉烯类耐药肺炎克雷伯菌院内感染暴发调查及防控策略  

Investigation of infection control and prevention strategies on carbapenem-resistant Klebsiella pneumoniae nosocomial outbreak in a hospital in Shandong Province

作　　者：任玉莲 陈晓燕[1] 纪晓[1] 刘爱华[1] 史世俊[2,3] REN Yulian;CHEN Xiaoyan;JI Xiao;LIU Aihua;SHI Shijun(Department of Infection Management,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji'nan,Shandong,250011,China;Shandong Institute of Parasitic Diseases,Ji'ning,Shandong 272000,China;Gastroenterology Hospital Affiliated to Shandong First Medical University,Ji'ning,Shandong 272000,China)

机构地区：[1]山东中医药大学附属医院感染管理办公室,山东济南250011 [2]山东省寄生虫病防治研究所,山东济宁272000 [3]山东第一医科大学附属消化病医院,山东济宁272000

出　　处：《中国热带医学》2025年第2期242-247,共6页China Tropical Medicine

摘　　要：目的 对山东某医院神经外科重症监护室一起碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumonia, CRKP)医院感染暴发事件进行分析调查,并按调查结果进行整改,为多重耐药菌医院感染暴发防控策略提供参考方案。方法 采用现场流行病学调查的方法对2021年山东某医院5例聚集性发病的CRKP肺部感染病例进行调查及环境卫生学监测,分析其发生的主要环节并采取有效的控制措施,并对防控措施的效果进行评价。结果 某神经外科重症监护室发生CRKP肺部感染暴发,感染病例床位及空间位置分布集中。对监护室内环境物体表面、医护和保洁人员的手及鼻腔进行卫生学监测,首次采样的样本中,患者床单元物表标本中有3份检出CRKP,其他物体表面、医务人员手和鼻腔、空气标本均未检测到CRKP。物体表面检出的CRKP阳性菌株与患者菌株药敏结果一致,采取综合防控措施后未再发生相关病例。结论 通过加强病区消毒隔离、加强医务人员手卫生管理及人员培训等综合管控措施,可有效控制神经外科重症监护室的CRKP医院感染暴发。Objective To analyze and investigate a hospital-acquired outbreak of carbapenem-resistant Klebsiella pneumoniae(CRKP)in a hospital's neurosurgical intensive care unit(NSICU),and to implement rectification based on the investigation results,providing valuable insights and recommendations for controlling similar outbreaks caused by multi-drug-resistant strains.Methods The field epidemiological investigation was conducted to investigate five cases of clustered CRKP pulmonary infection in the NICU in Shandong in 2021.Hygienic monitoring of the environment was undertaken.The main occurrence stages were analyzed,effective control measures were taken,and the effectiveness of the control measures was evaluated.Results The study identified an outbreak of CRKP infections that occurred in the neurosurgical intensive care unit,with the beds of infection cases and spatial positions being centrally distributed.Hygienic monitoring was performed on environmental surfaces,as well as the hands and nasal cavities of medical and cleaning staff.In the first sampling,3 samples from the patient bed units tested positive for CRKP,while no CRKP was detected on other surfaces,or in samples from the hands and nasal passages of the medical staff and air specimens.The CRKP strains found on surfaces had antibiotic resistance profiles consistent with the patient strains.No further related cases occurred after comprehensive control measures were implemented.Conclusions The comprehensive control measures,including enhanced ward disinfection and isolation,strict management of hand hygiene among medical staff,and personnel training,can effectively control the outbreak of CRKP hospital-acquired infections in NSICU.

关 键 词：医院感染 暴发 神经外科重症监护室 碳青霉烯类耐药肺炎克雷伯菌 调查 

分 类 号：R515[医药卫生—内科学]