ICU多重耐药鲍曼不动杆菌医院感染暴发流行病学调查

目的调查某院重症监护室（ICU）发生的多重耐药鲍曼不动杆菌医院感染暴发的原因。方法采用前瞻性和回顾性调查相结合的方法，对2012年1月25日-2月10日该院ICU发生的10例下呼吸道感染多重耐药鲍曼不动杆菌患者进行流行病学调查。结果10例患者痰培养分离的鲍曼不动杆菌，除对头孢哌酮/舒巴坦全敏感，左氧氟沙星中度敏感外，对其他16种抗菌药物基本耐药；7例患者经治疗好转后转出ICU，3例死亡。共采集环境标本（未做清洁前）104份，其中从水龙头、治疗车、床头柜、雾化器管道、呼吸机管道和呼吸机操作屏、医务人员手等16份标本分离到鲍曼不动杆菌；16份环境标本分离的鲍曼不动杆菌耐药谱与痰培养菌株一致。经采取综合性控制措施,很好地控制了疫情。结论此次ICU多重耐药鲍曼不动杆菌医院感染暴发流行与医务人员手及医疗环境污染密切相关。

Survey on an outbreak of healthcare associated infection with multidrug resistance Acinetobacter baumannii in an intensive care unitWANG Li1, ZHOU Feng ping2

Objective To investigate the causes of an outbreak of healthcare-associated infection （HA1） with multidrug resistance Acinetobacter baumannii （MDR-Ab） in an intensive care unit（ICU）. Methods By combination of prospective and retrospective investigation, 10 ICU patients who were infected with MDR-Ab lower respiratory infection from January 25 to February 10, 2012 were performed epidemiological study. Results Ab isolated from 10 pa- tients＇ sputum were resistant to 16 antimicrobial agents except sensitive to cefoperazone/sulbactam and intemediate sensitive to levofloxacirL Seven patients were recovered after therapy, 3 died. A total of 1（i）4 environmental specimens （before cleaning） were taken, Ab were imlated from 16 specimens such as faucet, treatment trolley, bedside table, nebulizer tube, breathing tube, operation screen of breathing machine, and trends of health care workers; Ab from 16 environmental specimens and patients sputum had the same amimicrobial resistance pattern. Outbreak was comrolled after comprehensive measures were taken. Conclusion The outbreak of MDR-Ab HAI in ICU is closely related to the contamination of health care workers＇ hands and hospital environment.