一起疑似母乳污染相关新生儿败血症事件的调查与控制

 目的 调查某院新生儿科新生儿败血症聚集事件发生的原因,评价相关控制措施的有效性。方法 对2019年4月23—25日该院新生儿科发生医院感染新生儿败血症的早产三胞胎进行流行病学调查,采集母乳及医院环境标本进行卫生学监测,针对存在的危险因素采取控制措施。结果 新生儿科除三胞胎新生儿外,无其他新生儿发生新生儿败血症。三胞胎新生儿均在开始母乳喂养约48 h发病,其中2例新生儿血培养均为阴沟肠杆菌。采集37份标本,4份标本细菌菌落数超标,仅母乳培养出阴沟肠杆菌,且菌落数>1 000 CFU/mL。暂停三胞胎新生儿母乳喂养,采取抗菌药物治疗,加强各项感染防控措施的管理,三胞胎新生儿均治愈出院,无新发病例出现。结论 母乳污染可能是此次聚集事件发生的原因。母乳采集过程中的污染不容忽视,新生儿科应实施母乳喂养规范化管理,将医院感染风险降至最低。

Investigation and control of a suspected neonatal septicemia related to breast milk contamination

Objective To investigate the causes of a clustering event of neonatal septicemia in the neonatal intensive care unit(NICU) of a hospital, evaluate the effectiveness of relevant control measures. Methods The preterm triplets with healthcare-associated neonatal septicemia in NICU of a hospital from April 23 to 25, 2019 were performed epidemiological survey, specimens of breast milk and hospital environment were collected for hygienic monitoring, and control measures were taken for the existing risk factors. Results There was no other neonatal septicemia case except triplets in NICU. Triplets all developed disease 48 hours after the start of breastfeeding, 2 neonates were isolated Enterobacter cloacae from blood culture. Among the 37 collected specimens, bacterial colony number of 4 specimens exceeded the standard, Enterobacter cloacae was only isolated from breast milk, and the colony number was>1 000 CFU/mL. Breastfeeding of triplets was suspended temporarily, antimicrobial treatment was given, and management of various infection prevention and control measures was strengthened, triplets were all cured and discharged from hospital, there was no new case. Conclusion Breast milk contamination may be the cause of this clustering event. In order to minimize the risk of healthcare-associated infection, standardized management of breastfeeding should be implemented in neonatal department.