一起疑似新生儿耐碳青霉烯类肺炎克雷伯菌血流感染聚集性事件的调查与处置

Investigation and disposal of a cluster of suspected neonatal bloodstream infection with carbapenem-resistant Klebsiella pneumoniae

目的调查某院新生儿科一起疑似新生儿耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染聚集性事件发生的原因,为有效控制医院感染事件的发生提供参考依据。方法对2023年1月31日—2月6日入住该院新生儿病房的3例CRKP血流感染新生儿进行流行病学调查,并采集病室环境物体表面进行环境卫生学监测,针对危险因素采取有效的控制措施。结果2023年1月31日—2月6日,新生儿病房共收治住院新生儿60例,经外周静脉置入中心静脉导管(PICC)16例,发生CRKP血流感染3例,罹患率5.00%。发生医院感染聚集性事件上报当天(2月7日)在院患者33例,现患率9.09%(3/33)。2023年1月31日—2月6日该院新生儿科CRKP引起的血流感染率高于2022年(P<0.001)。发生CRKP血流感染的3例新生儿暖箱在同一病室且为相邻位置,首例CRKP血流感染新生儿(1月31日发生血流感染)于2月4日进行PICC维护,且PICC维护顺序紧邻后2例发生CRKP血流感染的新生儿,3例新生儿血培养均检出CRKP,药敏结果一致。结论此次新生儿CRKP血流感染聚集性事件的发生可能与PICC维护过程中未严格执行无菌操作以及物品间存在交叉污染有关。

Objective To investigate the causes of a cluster of suspected neonatal carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection(BSI)in the neonatal department of a hospital,and provide references for the effective control of the occurrence of healthcare-associated infection(HAI).Methods Epidemiological investigation on 3 neonates with CRKP BSI in the neonatal department from January 31 to February 6,2023 was performed.Specimens from environmental object surfaces were taken for environmental hygiene monitoring,and effective control measures were taken according to the risk factors.Results From January 31 to February 6,2023,a total of 60 neonates were admitted in the neonatal department,including 16 with peripherally inserted central venous catheter(PICC).Three neonates had CRKP BSI,with a incidence of 5.00%.There were 33 hospitalized neonates on the day(February 7)when the cluster of HAI was reported,with a prevalence rate of 9.09%(3/33).CRKP BSI rate in the neonatal department of this hospital from January 31 to February 6,2023 was higher than that in 2022(P<0.001).The incubators of the 3 neonates with CRKP BSI were in the same ward and adjacent to each other.The first neonate with CRKP BSI(who developed BSI on January 31)underwent PICC maintenance on February 4,and the other 2 neonates with PICC maintenance immediately following the first one also developed CRKP BSI.CRKP were isolated from blood culture of all 3 neonates,and antimicrobial susceptibility testing results were consistent.Conclusion The occurrence of the cluster event of neonatal CRKP BSI may be related to the failure of strict implementation of aseptic procedures during PICC maintenance and cross contamination among items.