危重患者多药耐药鲍氏不动杆菌医院感染暴发的临床研究
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摘要
目的探讨某院住院危重患者发生感染暴发流行多药耐药鲍氏不动杆菌(MDR-AB)感染聚集的原因与干预方式,旨在为预防和控制院内MDR-AB感染提供一定的理论依据。方法调查2017年6月1-7日7例住院危重患者MDR-AB感染聚集病例鲍氏不动杆菌分离与感染情况,采集患者呼吸道标本进行病原学鉴定和药敏试验,对患者病床环境及医护人员的手等部位进行环境卫生学监测。结果 7例MDR-AB感染病例均患有严重的基础疾病,使用呼吸机时间12～30d,感染时间集中在2017年6月1-7日;药敏试验结果显示,患者呼吸道痰液标本分离出的7株MDR-AB对哌拉西林、头孢他啶、美罗培南等14种药物均耐药,耐药率100.00%;对阿米卡星、磺胺甲噁唑/甲氧苄啶、四环素部分耐药,耐药率分别为71.43%、57.14%、42.86%;对左氧氟沙星、米诺环素、多黏菌素E均敏感或中度敏感;环境采样培养共分离出25株MDR-AB,与患者呼吸道痰液标本中分离出的7株MDR-AB具有较高的同源性,其中5株来自1、2、5、6、7号病例医护人员的手,5株来自2、3、4、5、7号病例的呼吸机管道,4株来自1、2、3、6号病例的床栏,4株来自2、4、5、6号病例的被褥,3株来自3、4、5号病例的治疗车,2株来自4、7号病例的床头柜,2株来自1、5号病例的呼吸机进出口。结论医院环境因素与医护人员因素是本次MDR-AB感染暴发的主要原因,通过严格的环境消毒与手卫生可以有效避免MDR-AB感染。
OBJECTIVE To explore the causes of aggregation of multidrug-resistant Acinetobacter baumannii(MDRAB)infection in hospitalized critically ill patients and put forward the intervention measures so as to provide theoretical basis for prevention and control of the MDRAB infection.METHODS Totally 7 critically ill patients with cluster of MDRAB infection who were hospitalized from Jun 1,2017 to Jul 1,2017 were enrolled in the study,the prevalence of infection and isolation rate of Acinetobacter baumannii were investigated,the respiratory tract specimens were collected,the etiological test and drug susceptibility testing were performed,and the surveillance of environmental hygiene was carried out for beds and hands of health care workers.RESULTS All of the 7 patients with MDRAB infection had severe underlying diseases and were treated with ventilator for 12-30 days,and the time of infection gathered between Jan 1,2017 and Jul 1,2017.The result of the drug susceptibility testing showed that all of the 7 strains of MDRAB that were isolated from the respiratory sputum specimens were resistant to 14 types of antibiotics,including piperacillin,ceftazidime and meropenem,with the drug resistance rate 100.00%;the drug resistance rates to amikacin,sulfamethoxazole-trimethoprim and tetracycline were 71.43%,57.14%and 42.86%,respectively;the strains were sensitive or moderately sensitive to levofloxacin,minocycline and polymyxin E.A total of 25 strains of MDRAB were isolated from the environmental samples,which had high homology with the 7 strains of MDRAB that were isolated from the respiratory tract sputum specimens;5 strains were isolated from the hands of the health care workers of the No.1,2,5,6 and 7 patient,5 strains were isolated from the tubes of ventilators of the No.2,3,4,5 and 7 patient,4 strains were isolated from the bedrails of the No.1,2,3 and 6 patient,4 strains were isolated from the beddings of the No.2,4,5 and 6 patient,3 strains were isolated from the treatment vehicles of the No.3,4 and 5 patient,2 strains were isolated from the bedside tables of the No.4 and 7 patient,and 2 strains were isolated from the inlets and outlets of ventilators of the No.1 and 5 patient.CONCLUSIONThe environmental factors and health care workers are the leading factors for the outbreak of MDRAB infection;rigid environmental disinfection and hand hygiene may effectively prevent the MDRAB infection.
OBJECTIVE To explore the causes of aggregation of multidrug-resistant Acinetobacter baumannii(MDRAB)infection in hospitalized critically ill patients and put forward the intervention measures so as to provide theoretical basis for prevention and control of the MDRAB infection.METHODS Totally 7 critically ill patients with cluster of MDRAB infection who were hospitalized from Jun 1,2017 to Jul 1,2017 were enrolled in the study,the prevalence of infection and isolation rate of Acinetobacter baumannii were investigated,the respiratory tract specimens were collected,the etiological test and drug susceptibility testing were performed,and the surveillance of environmental hygiene was carried out for beds and hands of health care workers.RESULTS All of the 7 patients with MDRAB infection had severe underlying diseases and were treated with ventilator for 12-30 days,and the time of infection gathered between Jan 1,2017 and Jul 1,2017.The result of the drug susceptibility testing showed that all of the 7 strains of MDRAB that were isolated from the respiratory sputum specimens were resistant to 14 types of antibiotics,including piperacillin,ceftazidime and meropenem,with the drug resistance rate 100.00%;the drug resistance rates to amikacin,sulfamethoxazole-trimethoprim and tetracycline were 71.43%,57.14%and 42.86%,respectively;the strains were sensitive or moderately sensitive to levofloxacin,minocycline and polymyxin E.A total of 25 strains of MDRAB were isolated from the environmental samples,which had high homology with the 7 strains of MDRAB that were isolated from the respiratory tract sputum specimens;5 strains were isolated from the hands of the health care workers of the No.1,2,5,6 and 7 patient,5 strains were isolated from the tubes of ventilators of the No.2,3,4,5 and 7 patient,4 strains were isolated from the bedrails of the No.1,2,3 and 6 patient,4 strains were isolated from the beddings of the No.2,4,5 and 6 patient,3 strains were isolated from the treatment vehicles of the No.3,4 and 5 patient,2 strains were isolated from the bedside tables of the No.4 and 7 patient,and 2 strains were isolated from the inlets and outlets of ventilators of the No.1 and 5 patient.CONCLUSIONThe environmental factors and health care workers are the leading factors for the outbreak of MDRAB infection;rigid environmental disinfection and hand hygiene may effectively prevent the MDRAB infection.
引文
[1]谈宜斌,李源,田佳,等.重症监护病房鲍曼不动杆菌感染暴发事件调查[J].中国消毒学杂志,2018,35(8):627-629.
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[7]刘冲,苏建荣,闫东辉,等.重症监护病房多重耐药鲍曼不动杆菌感染及耐药性分析[J].中华检验医学杂志,2015,38(1):55-58.
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[10]Chusri S,Na-Phatthalung P,Siriyong T,et al.Holarrhena antidysenterica as a resistance modifying agent against Acinetobacter baumannii:Its effects on bacterial outer membrane permeability and efflux pumps[J].Microbiol Res,2014,169(5-6):417-424.
[11]Senchenkova SN,Shashkov AS,Shneider MM,et al.Structure of the capsular polysaccharide of Acinetobacter baumannii ACICU containing di-N-acetylpseudaminic acid[J].Carbohydr Res,2014,391:89-92.
[12]胡宇晴,马新然,冒文君,等.鲍曼不动杆菌血流感染预后不良的危险因素[J].中国感染控制杂志,2018,17(4):329-334.
[13]何禄娟,孟婕,黄大毛,等.ICU多重耐药鲍曼不动杆菌血流感染的回顾性分析[J].中南大学学报(医学版),2015,40(12):1327-1332.
[14]Zhang Y,Zhu Y,Gupta A,et al.Antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model:implications for prophylaxis and treatment of combat-related wound infections[J].J Infect Dis,2014,209(12):1963-1971.
[15]Lee HY,Chen CL,Wu SR,et al.Risk factors and outcome analysis of Acinetobacter baumannii complex bacteremia in critical patients[J].Crit Care Med,2014,42(5):1081-1088.
[16]徐跃峤,王宁,程玮涛,等.神经外科术后多重耐药鲍曼不动杆菌脑室炎的治疗[J].北京医学,2015,37(11):1075-1077.
[17]李娜,黄艳芳,唐喻莹,等.多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析[J].中国感染控制杂志,2017,16(2):115-120.
[18]Yokoyama Y,Matsumoto K,Ikawa K,et al.Pharmacokinetic/pharmacodynamic evaluation of sulbactam against Acinetobacter baumannii in in vitro and murine thigh and lung infection models[J].Int J Antimicrob Agents,2014,43(6):547-552.
[19]Kang CH,Tsai CM,Wu TH,et al.Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity[J].Pediatr Pulmonol,2014,49(4):381-388.
[20]Sun Y,Wang L,Li J,et al.Synergistic efficacy of meropenem and rifampicin in a murine model of sepsis caused by multidrug-resistant Acinetobacter baumannii[J].Eur J Pharmacol,2014,729:116-122.
[21]Gao J,Zhao X,Bao Y,et al.Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards[J].Burns,2014,40(2):295-299.
[22]de Leseleuc L,Harris G,KuoLee R,et al.Serum resistance,gallium nitrate tolerance and extrapulmonary dissemination are linked to heme consumption in a bacteremic strain of Acinetobacter baumannii[J].Int J Med Microbiol,2014,304(3-4):360-369.
[23]Ozgur ES,Horasan ES,Karaca K,et al.Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii:risk factors,clinical features,and outcomes[J].Am J Infect Control,2014,42(2):206-208.
[24]Kenyon JJ,Marzaioli AM,Hall RM,et al.Structure of the K2capsule associated with the KL2gene cluster of Acinetobacter baumannii[J].Glycobiology,2014,24(6):554-563.
[25]Longo F,Vuotto C,Donelli G.Biofilm formation in Acinetobacterbaumannii[J].New Microbiol,2014,37(2):119-127.
[2]张艺雄,张美芬.重症监护病房鲍曼不动杆菌感染危险因素的研究进展[J].中华现代护理杂志,2016,22(15):2217-2220.
[3]胡春华,杨怀德,王玉莲,等.多重耐药鲍曼不动杆菌医院感染聚集性病例的调查[J].中国感染控制杂志,2017,16(3):229-232.
[4]Teerawattanapong N,Panich P,Kulpokin D,et al.A systematic review of the burden of multidrug-resistant healthcareassociated infections among intensive care unit patients in southeast Asia:the rise of multidrug-resistant Acinetobacter baumannii[J].Infect Control Hosp Epidemiol,2018,39(5):525-533.
[5]Hrenovic J,Durn G,Goic-Barisic I,et al.Occurrence of an environmental Acinetobacter baumannii strain similar to a clinical isolate in paleosol from Croatia[J].Appl Environ Microbiol,2014,80(9):2860-2866.
[6]Todorova B,Velinov T,Ivanov I,et al.First detection of OXA-24carbapenemase-producing Acinetobacter baumannii isolates in Bulgaria[J].World J Microbiol Biotechnol,2014,30(4):1427-1430.
[7]刘冲,苏建荣,闫东辉,等.重症监护病房多重耐药鲍曼不动杆菌感染及耐药性分析[J].中华检验医学杂志,2015,38(1):55-58.
[8]任金芳,陈静.某医院重症监护室多重耐药鲍曼不动杆菌感染的危险因素及防控[J].解放军预防医学杂志,2015,33(3):285-286.
[9]中华人民共和国卫生部.医院感染管理办法[J].中国护理管理,2006,6(7):5-7.
[10]Chusri S,Na-Phatthalung P,Siriyong T,et al.Holarrhena antidysenterica as a resistance modifying agent against Acinetobacter baumannii:Its effects on bacterial outer membrane permeability and efflux pumps[J].Microbiol Res,2014,169(5-6):417-424.
[11]Senchenkova SN,Shashkov AS,Shneider MM,et al.Structure of the capsular polysaccharide of Acinetobacter baumannii ACICU containing di-N-acetylpseudaminic acid[J].Carbohydr Res,2014,391:89-92.
[12]胡宇晴,马新然,冒文君,等.鲍曼不动杆菌血流感染预后不良的危险因素[J].中国感染控制杂志,2018,17(4):329-334.
[13]何禄娟,孟婕,黄大毛,等.ICU多重耐药鲍曼不动杆菌血流感染的回顾性分析[J].中南大学学报(医学版),2015,40(12):1327-1332.
[14]Zhang Y,Zhu Y,Gupta A,et al.Antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model:implications for prophylaxis and treatment of combat-related wound infections[J].J Infect Dis,2014,209(12):1963-1971.
[15]Lee HY,Chen CL,Wu SR,et al.Risk factors and outcome analysis of Acinetobacter baumannii complex bacteremia in critical patients[J].Crit Care Med,2014,42(5):1081-1088.
[16]徐跃峤,王宁,程玮涛,等.神经外科术后多重耐药鲍曼不动杆菌脑室炎的治疗[J].北京医学,2015,37(11):1075-1077.
[17]李娜,黄艳芳,唐喻莹,等.多重耐药鲍曼不动杆菌医院感染危险因素荟萃分析[J].中国感染控制杂志,2017,16(2):115-120.
[18]Yokoyama Y,Matsumoto K,Ikawa K,et al.Pharmacokinetic/pharmacodynamic evaluation of sulbactam against Acinetobacter baumannii in in vitro and murine thigh and lung infection models[J].Int J Antimicrob Agents,2014,43(6):547-552.
[19]Kang CH,Tsai CM,Wu TH,et al.Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity[J].Pediatr Pulmonol,2014,49(4):381-388.
[20]Sun Y,Wang L,Li J,et al.Synergistic efficacy of meropenem and rifampicin in a murine model of sepsis caused by multidrug-resistant Acinetobacter baumannii[J].Eur J Pharmacol,2014,729:116-122.
[21]Gao J,Zhao X,Bao Y,et al.Antibiotic resistance and OXA-type carbapenemases-encoding genes in airborne Acinetobacter baumannii isolated from burn wards[J].Burns,2014,40(2):295-299.
[22]de Leseleuc L,Harris G,KuoLee R,et al.Serum resistance,gallium nitrate tolerance and extrapulmonary dissemination are linked to heme consumption in a bacteremic strain of Acinetobacter baumannii[J].Int J Med Microbiol,2014,304(3-4):360-369.
[23]Ozgur ES,Horasan ES,Karaca K,et al.Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii:risk factors,clinical features,and outcomes[J].Am J Infect Control,2014,42(2):206-208.
[24]Kenyon JJ,Marzaioli AM,Hall RM,et al.Structure of the K2capsule associated with the KL2gene cluster of Acinetobacter baumannii[J].Glycobiology,2014,24(6):554-563.
[25]Longo F,Vuotto C,Donelli G.Biofilm formation in Acinetobacterbaumannii[J].New Microbiol,2014,37(2):119-127.