疑似耐碳青霉烯类肺炎克雷伯菌感染暴发调查

Investigation of a suspected outbreak of carbapenem-resistant Klebsiella pneumonia infection

【目的】对某二级甲等综合性医院1起疑似耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发事件进行调查,分析感染源和传播途径,提出针对性的干预控制措施。【方法】对2021年12月23日—12月30日神经外科5例CRKP感染患者进行流行病学调查,按照环境微生物学监测方法采集标本,查找环境中的CRKP菌株,应用多位点序列分型(MLST)方法分析环境分离菌株,采取综合性控制措施进行干预。【结果】5例感染患者位于3个房间,均诊断为医院获得性肺部感染。其中3例患者标本检出的CRKP细菌药敏结果相同。通过环境卫生学监测,从3个房间的水龙头把手和水槽表面标本检出CRKP菌株。MLST分析结果显示,房间2和房间3的水龙头把手和水槽标本均为ST11型,房间1的环境标本为ST23型。采取综合性干预措施后,本次疑似暴发得到有效控制。【结论】本次医院感染暴发可能是由于CRKP感染患者的病原体污染环境以及医护、陪护家属等人员的手部传播。加强医护人员及陪护人员的宣教和管理,早期识别感染暴发,及时采取综合性控制措施是预防多重耐药菌医院感染暴发的关键。

[Objective]To investigate a suspected outbreak of healthcare-associated infection(HAI)caused by carbapenem-resistant Klebsiella pneumonia(CRKP)in a secondary grade-A hospital,analyze the infection source and transmission route,and put forward corresponding preventive and control measures.[Methods]Epidemiological investigation was conducted on 5 patients with CRKP infection in department of neurosurgery during December 23-30,2021.Specimens were collected with the environmental microbiology monitoring procedure.CRKP isolated from the environmental samples were analyzed by multilocus sequence typing(MLST)method.Comprehensive measures were taken to control the CRKP infection.[Results]The 5 infected patients were located in 3 rooms,and all were diagnosed as HAI.The antimicrobial susceptibility testing results from the specimens of 3 CRKP infected patients were the same.Through environmental microbiology monitoring,CRKP strains were detected from the faucet handle and sink specimens in 3 rooms.The results of MLST analysis showed that the faucet handle and sink specimens in room 2 and 3 were ST11 type.The environmental specimen in room 1 was ST23 type.The suspected outbreak was effectively controlled after comprehensive interventions.[Conclusion]HAI suspected outbreak might be caused by the environmental contamination from the pathogens of CRKP-infected patients as well as the contaminated hands of medical staff and accompanying family members.Strengthening the publicity,education and management of medical staff and accompanying staff,early identification of infection outbreaks,and timely comprehensive control measures are the keys to controlling multidrug-resistant nosocomial infection outbreaks.