多药耐药鲍氏不动杆菌感染的调查分析及控制措施

Multidrug-resistant Acinetobacter baumannii infections and control measures

目的调查某院多药耐药鲍氏不动杆菌(MDRAB)感染原因,探讨控制措施的有效性。方法对2011年1月1日-2月15日发生在某院部分重点科室MDRAB感染进行危险因素调查分析,并对ICU环境微生物进行采样分析,实施紧急综合控制措施。结果 2011年1月1日-2月15日检出MDRAB 56株,明显高于2010年同期及前期水平;大部分患者基础病严重、高龄、气管切开或插管;环境微生物监测结果显示,空气中未检出MDRAB,物体表面消毒前18份标本中检出MDRAB 12株;其中6株耐药率与患者接近,具有一定的表型同源性;非MDRAB感染患者的物体表面未检出MDRAB;工作人员手7份,检出1株MDRAB;采取综合控制措施1个月后,全院MDRAB的检出率明显下降。结论启动紧急控制预案,成立多药耐药菌管理小组与控制小组,强化MDRAB患者的隔离管理、病历排查、物体表面消毒频次及手卫生,加强现场培训与指导,可有效控制MDRAB的流行与暴发。

OBJECTIVE To investigate the causes of multidrug-resistant Acinetobacter baumannii infections and discuss the effectiveness of the control measures. METHODS The risk factors of multidrug-resistant A. baumannii infections which occurred in key departments from Jan 1 to Feb 15,2011 were investigated, then environmental organisms were sampled from ICU, and the emergency comprehensive control measures were taken. RESULTS Totally 56 strains of multidrug-resistant A. baumannii have been detected from Jan 1 to Feb 15,2011, and the detection rate has been significantly higher than that of the same period of 2010 and the previous periods. Most of the patients were with severe underlying diseases and advanced age and underwent tracheotomy or intubation. The result of the surveillance of environmental organisms indicated that no strains of multidrug-resistant A. baumannii were detected from the air and that 12 strains of multidrug-resistant A. baumannii were detected from 18 specimens before the disinfection of object surfaces l among the 12 strains of multidrug-resis.tant A. baurnannii, the drug resistance rate of 6 strains was similar to that of the strains isolated from the patients, with certain phenotype homology the multidrug-resistant A. baumannii strains have not been detected from the object surfaces l 1 strain was isolated from the specimens obtained from medical staff＇s hands. The detection rate of multidrugresistant A. baurnannii in the whole hospital was significantly decreased after the comprehensive control measures were taken for one month. CONCLUSION It is necessary to launch emergency control program, establish the team of management and control of multidrug-resistant bacteria , enhance the isolation of the patients with multidrugresistant A. baumannii infections, exclusion of medical records, disinfection of object surfaces, and hand hygiene, and strengthen the on-site training so as to effectively control the outbreak and prevalence of multidrug-resistant A. baurnannii.