神经外科重症监护病房角膜假丝酵母菌导管相关血流感染暴发的调查与控制

Investigation and control of outbreaks of Candida Pelliculosa catheter-related bloodstream infection in the neurosurgical intensive care unit

目的:调查侯马市人民医院神经外科重症监护病房(ICU)角膜假丝酵母菌引起的导管相关血流感染暴发的原因,查找传染源和传播途径,为预防和控制医院感染提供依据。方法:对侯马市人民医院神经外科ICU 2019年3-4月角膜假丝酵母菌引起的导管相关血流感染患者进行流行病学调查以及环境卫生学监测,采取综合措施控制暴发流行。结果:该院神经外科ICU短时间内有4例患者发生角膜假丝酵母菌引起的导管相关血流感染,4例患者共采集8份标本分离到10个菌株,均鉴定为角膜假丝酵母菌,药敏试验结果完全相同,5-氟胞嘧啶最低抑菌浓度(MIC)≤4 mg/L,两性霉素B MIC≤0.5 mg/L,氟康唑 MIC<1 mg/L,伊曲康唑MIC≤0.12 mg/L,伏立康唑MIC≤0.06 mg/L。未从环境中检出目标菌,但采取加强医务人员手卫生监督及环境彻底消毒等综合控制措施后,未再出现角膜假丝酵母菌感染病例。结论:神经外科ICU医务人员手卫生依从性差及环境消毒不彻底可能是导致该次导管相关血流感染暴发的主要原因。

Objective To investigate the causes of the outbreak of Candida Pelliculosa catheter-related bloodstream infection in the neurosurgical intensive care unit(ICU),find out the source of infection and the route of transmission,and provide evidence for the prevention and control of nosocomial infection.Methods An epidemiological investigation and environmental hygiene monitoring were made in patients with Candida Pelliculosa catheter-related bloodstream infection who received treatment in March and April 2019 in Houma People's Hospital,China.Comprehensive measures were taken to control the outbreaks of Candida Pelliculosa catheter-related bloodstream infection.Results There were four patients with Candida Pelliculosa catheter-related bloodstream infection in the ICU of Neurosurgery Department of Houma People's Hospital,China.Eight samples were collected from these four patients.Ten strains were isolated and identified positive for Candida Pelliculosa.Drug sensitivity test revealed identical results:the minimum inhibitory concentration(MIC)of 5-fluorocytosine,amphotericin B,fluconazole,itraconazole and voriconazole was≤4 mg/L,≤0.5 mg/L,<1 mg/L,≤0.12 mg/L and≤0.06 mg/L,respectively.No target bacteria were detected from the environment.Candida Pelliculosa infection was not observed after taking comprehensive control measures such as strengthening hand hygiene supervision in medical staff and thorough disinfection of the environment.Conclusion Poor hand hygiene compliance in medical staff in neurosurgical ICU and non-sufficient environmental disinfection may be the main causes for the outbreak of Candida Pelliculosa catheter-related bloodstream infection.