重症监护病房MRSA感染暴发调查及对策

Outbreak of MRSA Infection in Intensive Care Unit:Survey and Countermeasure

目的对医院急诊重病监护病房发生耐甲氧西林金黄色葡萄球菌(MRSA)感染的暴发进行调查,查明感染的原因、危险因素,为控制医院感染提供依据和对策。方法按《医院消毒技术规范》要求采样,按《全国临床检验操作规程》细菌分离培养进行细菌鉴定和药敏试验。结果发现此次暴发感染源为院外转入1例金黄色葡萄球菌肺部感染患者,最危险因素为患者气管切开,其次是医务人员手交叉接触,再次为气候环境和病原菌因素等;患者痰标本和环境中分离的金黄色葡萄球菌均为MRSA,对青霉素、苯唑西林、庆大霉素、左氧氟沙星、头孢唑林耐药率为100%,对复方新诺明敏感率分别为100%、87%,对替考拉宁、万古霉素敏感率均为100%,环境分离株和感染株药敏谱高度相似性,可初步推测为同源菌株。结论金黄色葡萄球菌广泛存在重症监护病房,是引起重症患者呼吸道感染的主要致病菌,加强医务人员的手卫生,做好感染患者的隔离,严格执行无菌技术操作,加强病房管理和消毒隔离等措施达到控制呼吸道医院感染暴发流行的目的。

OBJECTIVE To investigate the outbreak infection of meticillin-resistant Staphylococcus aureus （MRSA） in ICU and find out the reason and risk factors which can provide a basis for measurement of controlling the hospital infection. METHODS The samples were collected according to the Technical Standard for Disinfection, and the bacterial identification and drug sensitivity test were conducted according to National Clinical Test Operation Regulation. RESULTS The outbreak infection source was from a patient with pulmonary infection by S. aureus out of hospital. The most important risk factor was the tracheotomy, followed by the hand cross contacting of healthcare workers, climate environment and pathogens etc. The S. aureus from the sputum specimens and environment was all MRSA which was 100% resistance to penicillin, oxacillin, gentamicin, levofloxacin and cefazolin, its sensitivity to SMZco was 100% and 87%, respectively, and the sensitivity to teieoplanin and vancomycin was 100%. The strains from the environment and patient had the high similarity, perhaps they were the homologous strains. CONCLUSIONS The S. aureus as a main pathogen is widely existed in ICU which is due to the respiratory tract infection of severe patients. In order to control the respiratory tract hospitial outbreak infection, we should strengthen the hand hygiene of heahhcare workers, do the isolation of the infected patient well, strictly obey the aseptic operation and strengthen ward management, disinfection and ventilator pipeline etc.