洋葱伯克霍尔德菌下呼吸道感染流行病学调查

Epidemiological survey of Burkholderia cepacia lower respiratory tract infection

目的对心脏外科重症监护室(CSICU)患者下呼吸道洋葱伯克霍尔德菌(BC)疑似医院感染暴发进行流行病学调查,为感染防控提供科学依据。方法2020年3月16日-28日心脏大血管外科手术后入住重症监护室的患者中,先后出现5例下呼吸道感染,细菌培养均为洋葱伯克霍尔德菌,考虑为“疑似医院感染暴发”。对5例感染患者的三间分布进行调查,采集CSICU及手术室环境卫生学标本、共同侵入性操作医疗用品、医务人员手卫生、食道超声探头、呼吸机及其附件等标本,进行病原菌培养鉴定及药敏试验。结果5例患者手术均在10号手术间进行,麻醉师均为H医生,手术间内已开启及未开启的大瓶装非消毒型耦合剂检出BC阳性率为100%,与患者痰培养分离的BC耐药谱基本一致;CSICU及手术室环境卫生学标本不合格率为14.29%,均无致病菌及目标菌(BC)生长。结论此次事件因麻醉师进行食道超声探头插入时,使用大瓶非消毒型耦合剂介导,大瓶非消毒型耦合剂为BC污染耦合剂,导致5例患者术后发生BC下呼吸道感染,停用大瓶非消毒型耦合剂改用单包装消毒型耦合剂后,未再发生BC致下呼吸道聚集感染。

OBJECTIVE To conduct the epidemiological survey of the patients with lower repertory tract B.cepacia infection and suspected for outbreak of nosocomial infection in cardiac surgery intensive care unit(CSICU)so as to provide scientific basis for prevention and control of the infection.METHODS From Mar 16,2020 to Mar 28,2020,the patients who underwent cardiac major vascular surgery and were hospitalized in ICU were enrolled in the study,and 5 patients successively had lower respiratory tract infection,the result of bacterial culture showed that the strains were B.cepacia.The three-room distribution of the 5 patients with the infection was investigated.The specimens were collected from CSICU and environmental hygiene of operating rooms,medical supplies for common invasive operations,hand hygiene of medical staff,esophageal ultrasound probes and ventilators and their attachments,the culture of pathogens was carried out,the isolated pathogens were identified,and the drug susceptibility testing was performed.RESULTS All of the 5 patients underwent surgeries in NO.10 operating room,and the anesthetist was doctor H.The positive rate of BC was 100%among the opened and unopened big-bottled non-disinfected coupling agents,and the drug resistance spectrum of the BC strains isolated from sputum specimens was basically same.the unqualified rate of the specimens from CSICU and environmental hygiene of operating room was 14.29%,there was no growth of pathogenic bacteria or target bacteria(BC).CONCLUSION The use of a large bottle of non-disinfected coupling agent for mediation of esophageal probe insertion and contaminated coupling agent with BC contribute to the postoperative lower respiratory tract infection in the 5 patients.The BC-induced lower respiratory tract cluster infection dose not occur after the large bottle of non-disinfected coupling agent is replaced by single-package disinfected coupling agent.