ICU一起疑似泛耐药鲍氏不动杆菌暴发调查与控制
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摘要
目的通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施。方法通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验。患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析。结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14%;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型。结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制。
OBJECTIVE To investigate the outbreak of suspected pan-drug resistant Acinetobacter baumannii(PDR-AB)infection in ICU,and to study the cluster-based strategy for preventation and control of pandrug resistant A baumannii nosocomial infection,so as to guide the implementation of preventation and control measures for nosocomial infections.METHODS We conducted the survey by means of molecular epidemiological analysis combined with environmental hygiene monitoring to collect more information about the isolation and infection of PDRAB in ICU from Feb.to Apr.2018.Environmental microorganism sampler was used to collect samples from the environment and items with suspected contamination for identification and drug sensitivity test.The homology of strains isolated from the patients and environment were studied using PFGE technique.RESULTS In Mar.2018,there were 7 cases of A baumannii infection or colonization in ICU,with the new infection rate of 10.14%.PDRAB were isolated from the head cushion towel,bed tail plate and bed bar of patients with PDR-AB colonization or infection,table top of nurse station,care clothing of the medical staff and the bronchofiberscope after cleaning and disinfection.Drug sensitivity test showed that the resistance spectra of the 27 strains of PDR-AB isolated from ICU patients and the environment were basically the same,and the PFGE results revealed that the PDR-AB strains isolated from the patients,environment and bronchofiberscope belonged to the same subtype.CONCLUSIONThe cloned strains of PDR-AB are highly homologous to each other among patients,the environment and bronchofiberscope.The outbreak situation can be effectively controlled by strengthening the aseptic concept of clinical medical and nursing staff,isolation of patients,strict cleaning and disinfection of the environment and medical equipment.
OBJECTIVE To investigate the outbreak of suspected pan-drug resistant Acinetobacter baumannii(PDR-AB)infection in ICU,and to study the cluster-based strategy for preventation and control of pandrug resistant A baumannii nosocomial infection,so as to guide the implementation of preventation and control measures for nosocomial infections.METHODS We conducted the survey by means of molecular epidemiological analysis combined with environmental hygiene monitoring to collect more information about the isolation and infection of PDRAB in ICU from Feb.to Apr.2018.Environmental microorganism sampler was used to collect samples from the environment and items with suspected contamination for identification and drug sensitivity test.The homology of strains isolated from the patients and environment were studied using PFGE technique.RESULTS In Mar.2018,there were 7 cases of A baumannii infection or colonization in ICU,with the new infection rate of 10.14%.PDRAB were isolated from the head cushion towel,bed tail plate and bed bar of patients with PDR-AB colonization or infection,table top of nurse station,care clothing of the medical staff and the bronchofiberscope after cleaning and disinfection.Drug sensitivity test showed that the resistance spectra of the 27 strains of PDR-AB isolated from ICU patients and the environment were basically the same,and the PFGE results revealed that the PDR-AB strains isolated from the patients,environment and bronchofiberscope belonged to the same subtype.CONCLUSIONThe cloned strains of PDR-AB are highly homologous to each other among patients,the environment and bronchofiberscope.The outbreak situation can be effectively controlled by strengthening the aseptic concept of clinical medical and nursing staff,isolation of patients,strict cleaning and disinfection of the environment and medical equipment.
引文
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[24]谈宜斌,李源,田佳,等.重症监护病房鲍曼不动杆菌感染暴发事件调查[J].中国消毒学杂志,2018,35(8):627-629.
[25]孙世鹏,旷南岳,漆新文.多重耐药鲍曼不动杆菌感染相关危险因素及耐药性分析[J].临床合理用药,2018,11(1A):7-11.
[26]Ying Q,Qun L,Qinzhong L,et al.Investigation and control of a suspected nosocomial outbreak of pan-drug resistant Acinetobacter baumannii in an intensive care unit[J].Open Med(Wars),2016,11(1):587-592.
[2]Doi Y,Murray GL,Peleg AY.Acinetobacter baumannii:evolution of antimicrobial resistance-treatment options[J].Semin Respir Crit Care Med,2015,36(1):85-98.
[3]Asif M,Alvi IA,Rehman SU.Insight into Acinetobacter baumannii:pathogenesis,global resistance,mechanisms of resistance,treatment options,and alternative modalities[J].Infect Drug Resist,2018,11:1249-1260.
[4]王珀.228株鲍曼不动杆菌感染的临床分布和耐药性分析[J].中国当代医药,2018,25(27):129-131.
[5]归巧娣,解娟,范芸,等.2014-2016年ICU鲍曼不动杆菌耐药结果分析[J].2018,34(12):1126-1128.
[6]Gao L,Lyu Y,Li Y.Trends in drug resistance of Acinetobacter baumannii over a 10-year Period:nationwide data from the China Surveillance of Antimicrobial Resistance Program[J].Chin Med J(Engl),2017,130(6):659-664.
[7]Levy-Blitchtein S,Roca I,Plasencia-Rebata S,et al.Emergence and spread of carbapenem-resistant Acinetobacter baumannii international clonesⅡandⅢin Lima,Peru[J].Emerg Microbes Infect,2018,7(1):119.
[8]Halachev MR,Chan JZ,Constantinidou CI,et al.Genomic epidemiology of a protracted hospital outbreak caused by multidrug-resistant Acinetobacter baumannii in Birmingham,England[J].Genome Medicine,2014,6(11):70.
[9]Warner WA,Kuang SN,Hernandez R,et al.Molecular characterization and antimicrobial susceptibility of Acinetobacter baumannii isolates obtained from two hospital outbreaks in Los Angeles County,California,USA[J].BMC Infect Dis,2016,16:194.
[10]宋志伟,郏伊范,沈伟伟,等.医院感染鲍氏不动杆菌耐药分析及同源性研究[J].中华医院感染学杂志,2017,27(13):2904-2907.
[11]Shamsizadeh Z,Nikaeen M,Nasr Esfahani B,et al.Detection of antibiotic resistant Acinetobacter baumannii in various hospital environments:potential sources for transmission of Acinetobacter infections[J].Environ Health Prev Med,2017,22(1):44.
[12]王中强.特殊血清型志贺菌、猪链球菌和产NDM-1鲍曼不动杆菌分子分型及遗传变异分析[D].军事医学科学院硕士学位论文,2011.
[13]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[14]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
[15]Clinical and Laboratory Standards Institute.Performanee standards for antimicrobial suseeptitfility testing;sixteenth informational supplement.Wayne,Pa[J].Clinical and Laboratory Standards Institute,2017:M100-S27.
[16]汪洋,吴晓松,黄立业,等.一起鲍氏不动杆菌医院感染暴发的调查[J].中医院感染学杂志,2017,27(9):1940-1943.
[17]高树芳.ICU疑似泛耐药鲍曼不动杆菌肺部感染暴发调查分析[J].海峡预防医学志,2017,23(2):27-29.
[18]Umezawa K,Asai S,Ohshima T,et al.Outbreak of drugresistant Acinetobacter baumannii ST219caused by oral care using tap water from contaminated hand hygiene sinks as a reservoir[J].Am J Infect Control,2015,43(11):1249-1251.
[19]Chen CH,Lin LC,Chang YJ,et al.Infection control programs and antibiotic control programs to limit transmission of multi-drug resistant Acinetobacter baumannii infections:evolution of old problems and new challenges for institutes[J].Int J Environ Res Public Health,2015,12(8):8871-8882.
[20]Al-Anazi KA,Al-Jasser AM.Infections caused by Acinetobacter baumannii in recipients of hematopoietic stem cell transplantation[J].Front Oncol,2014,4:186.
[21]李璇,旷南岳,涂新文.抗菌药物对鲍曼不动杆菌多重耐药及感染预后的影响[J].医药导报,2018,37(3):325-328.
[22]中华人民共和国国家卫生和计划生育委员会,软式内镜清洗消毒技术规范[S].北京,2016.
[23]赵慧颖,杨艟舸,郭杨,等.内科重症监护病房泛耐药鲍曼不动杆菌定植与感染的监测及控制[J].中华危重病急救医学,2014,26(7):464-467.
[24]谈宜斌,李源,田佳,等.重症监护病房鲍曼不动杆菌感染暴发事件调查[J].中国消毒学杂志,2018,35(8):627-629.
[25]孙世鹏,旷南岳,漆新文.多重耐药鲍曼不动杆菌感染相关危险因素及耐药性分析[J].临床合理用药,2018,11(1A):7-11.
[26]Ying Q,Qun L,Qinzhong L,et al.Investigation and control of a suspected nosocomial outbreak of pan-drug resistant Acinetobacter baumannii in an intensive care unit[J].Open Med(Wars),2016,11(1):587-592.