呼吸内科重症监护室一起多重耐药鲍曼不动杆菌感染暴发的调查

An outbreak of multi-drug resistant Acinetobacter baumannii in respiratory intensive care unit:investigation and management

目的及时发现医院感染暴发苗头,查找感染源,切断传播途径,最大限度减少医院感染发生。方法对2009年4月26～28日期间RICU发生的4例鲍曼不动杆菌感染病例进行聚集感染危险因素调查,采集标本进行目标菌检测,应用ERIC-PCR技术对聚集病例和散发病例菌株进行基因同源性分析,采取综合性防控措施进行医院感染具体干预。结果 4例患者确定为医院感染病例,4例患者均有气管插管操作经历,3例患者环境卫生学检测存在耐药谱相同的鲍曼不动杆菌,ERIC-PCR分析4例患者检出的鲍曼不动杆菌具有基因同源性,确定为医院感染暴发。严格执行隔离防护措施和后续加强上呼吸机患者管理,未再出现聚集病例。结论医院感染暴发危及患者医疗安全,应用分子生物学分析手段可以促进医院感染防控措施的效果;加强上呼吸机患者的管理,加强手卫生的管理可以有效防控医院感染聚集暴发。

Objective To find the sign of nocomical outbreak, search for the infection sources and cut off the transmission routes, so as to minimize the nocomial infections. Method 4 cases of CRAB infections during 26th to 28th of April in 2009 were investigated. ERIC-PCR was performed to analyze the gene homology of CRABs. Comprehensive intervention measures were taken. Result The 4 cases were eofirmed to have the same genetype, and the outbreak of CRAB infections was assured. The outbreak was controlled by data feedback and intervention. Conclusion The outbreak of nosocomial infections en- dangers patients＇ safety. Molecular biological analysis and feedback can help preventing and controlling infections.