多重耐药鲍曼不动杆菌医院感染聚集性病例的调查

Clustered cases of healthcare-associated infection due to multidrugresistant Acinetobacter baumannii

目的了解某院重症监护病房(ICU)多重耐药鲍曼不动杆菌(MDR-AB)医院感染聚集性病例的感染源和传播途径,为预防和控制医院感染提供支持依据。方法调查该院ICU MDR-AB医院感染聚集性病例,采集MDR-AB感染患者标本和环境标本进行培养,同时对分离菌株进行药敏试验。结果医院感染患者的痰标本中共分离病原菌5株,5例感染患者均来自同一ICU,且床位相邻;发病时间为2016年1月2—7日,相对集中。同期内环境标本中分离病原菌21株,菌株分别来自感染患者所在病区的被子、床头柜、治疗车、水龙头、床栏、呼吸机管道和医务人员手,其他环境标本中未检出该菌。患者和环境来源的菌株药敏鉴定均为MDR-AB,且耐药谱基本一致。结论此次医院感染聚集性病例的发生主要是由于ICU医疗环境和医务人员手被MDR-AB污染所致。

Objective To investigate the sources and transmission routes of clustered cases of healthcare-associated infection（HAI）caused by multidrug-resistant Acinetobacter baumannii（MDR-AB）in the intensive care unit（ICU）of a hospital,and provide evidence for the prevention and control of HAI.Methods Clustered cases of MDR-AB HAI in ICU were investigated,specimens of patients and environment were collected and cultured,the isolated strains were performed antimicrobial susceptibility testing.Results Five strains of pathogenic bacteria were isolated from sputum of patients with HAI,5infected patients were at adjacent beds from the same ICU;the onset time was on January 2-7,2016.A total of 21 strains of pathogenic bacteria were isolated from environmental specimens during the same period,these strains were from quilt,bedside cabinet,treatment trolley,faucet,bedrail,breathing tube,and hands of health care worker（HCWs）.Antimicrobial susceptibility testing results showed that strains from patients and environment were all MDR-AB,and had the similar antimicrobial resistance pattern.Conclusion The occurrence of clustered HAI cases is due to contamination of HCWs＇ hands and hospital environment by MDR-AB.