Simor Andrew E, Lee Mark, Vearncombe Mary, Jones-Paul Linda, Barry Clare, Gomez Manuel, Fish Joel S, Cartotto Robert C, Palmer Robert, Louie Marie
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York, Ontario, Canada.
Infect Control Hosp Epidemiol. 2002 May;23(5):261-7. doi: 10.1086/502046.
To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.
A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.
Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.
A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P < .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1; P = .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1; P= .02).
Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions.
Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.
描述多重耐药鲍曼不动杆菌暴发的调查与管理，并确定该病原体感染的危险因素。
加拿大一家三级护理教学医院的一个拥有14张床位的区域烧伤病房。
采用病例对照研究，运用逻辑回归分析对潜在危险因素进行多变量分析。从医院环境、未感染患者及医护人员处采集监测培养样本。
1998年12月至2000年3月期间，247例急性烧伤患者中有31例（13%）感染了多重耐药鲍曼不动杆菌；其中18例（58%）患者发生感染。该病原体在医院环境及医护人员手上均有检出。感染多重耐药鲍曼不动杆菌的显著危险因素包括接受血制品（比值比[OR]为10.8；95%置信区间[CI95]为3.4至34.4；P<0.001）；在水疗室进行的操作（OR为4.1；CI95为1.3至13.1；P=0.02）；机械通气时间延长（OR为每天1.1；CI95为1.0至1.1；P=0.02）。
提高手卫生依从性、严格患者隔离、细致环境清洁以及该病房暂停接收新患者。
多重耐药鲍曼不动杆菌感染可能是多因素导致的，与环境污染及接触暂时定植的医护人员有关。针对这些多重耐药鲍曼不动杆菌潜在来源的控制措施成功终止了此次暴发。持续监测并持续关注手卫生及充分的环境清洁对于预防烧伤病房因耐抗生素细菌导致的反复暴发至关重要。
