神经外科耐碳青霉烯类肺炎克雷伯菌感染暴发调查与控制

目的对某院神经外科一起疑似耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染暴发事件进行调查,查找感染源及传播途径,提出针对性的预防控制措施。方法对2018年6月12日—7月2日该院神经外科11例CRKP感染患者进行流行病学调查,并采取综合性控制措施控制CRKP感染。结果 11例CRKP感染患者中7例诊断为医院感染。对其中6株CRKP采用肠杆菌基因间重复一致序列聚合酶链反应技术进行同源性分析,结果显示,检出A、B两种基因型,2例患者感染的CRKP菌株为A型基因,4例患者(包括3例医院感染患者)感染的CRKP菌株为B型基因。患者环境物体表面,以及部分医务人员手、咽拭子检出CRKP。结论该院存在医院感染暴发,可能是CRKP感染患者的病原体污染环境和医务人员的手导致感染的传播。早期识别感染暴发,并采取手卫生、环境物体表面的清洁消毒以及隔离等措施是控制多重耐药菌医院感染暴发的关键。

Investigation and control of an outbreak of carbapenem-resistant Klebsiella pneumoniae infection in department of neurosurgery

Objective To investigate a suspected outbreak of healthcare-associated infection(HAI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in department of neurosurgery of a hospital, find out the source and transmission route of infection, and put forward corresponding preventive and control measures. Methods From June 12 to July 2, 2018, 11 patients with CRKP infection in department of neurosurgery were investigated, comprehensive measures were taken to control CRKP infection. Results Seven of 11 patients with CRKP infection were dia-gnosed as HAI. Enterobacterial repetitive intergenic consensus polymerase chain reaction(ERIC-PCR) was used to perform homology analysis of 6 strains of CRKP, two genotypes A and B were detected, CRKP strains infected by 2 patients were type A gene, and infected by 4 patients (including 3 patients with HAI) were type B gene. CRKP was also isolated from patients' environmental object surface, as well as hands and throat swabs of partial health care workers(HCWs). Conclusion There is an outbreak of HAI in this hospital, which may be caused by contamination of environment by CRKP from infected patients and hands of HCWs. Early identification of infection outbreak, implementation of hand hygiene, cleaning and disinfection of environmental surface, as well as isolation measures are the key to control the outbreak of HAI caused by multidrug-resistant organisms.