Melamed R, Greenberg D, Porat N, Karplus M, Zmora E, Golan A, Yagupsky P, Dagan R
The Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Hosp Infect. 2003 Jan;53(1):31-8. doi: 10.1053/jhin.2002.1324.
We describe an outbreak of Acinetobacter baumannii in a neonatal intensive care unit (NICU), and our investigation to determine the source and mode of transmission and identify the population at risk. A case (infected infant) was defined as a patient hospitalized in the NICU during the outbreak period, with clinical signs of sepsis and isolation of A. baumannii. In colonized infants, A. baumannii was isolated from body surfaces without signs of infection. Infected infants were separated and treated by a different medical team. Cultures were taken from working surfaces and along the infant's admission passage from the delivery room to the NICU. The outbreak strain was identified by pulsed-field gel electrophoresis (PFGE). Nine cases and eight colonized infants met the definition criteria. Cases were younger than colonized infants with regard to gestational age and age of diagnosis and had lower birthweights (P<0.01). The outbreak strain was only isolated from hygroscopic bandages used on skin under the ventilation tube and umbilical catheters. Discontinuing the use of the bandages put an end to the outbreak. We conclude that a rapid and thorough investigation of the environment during an outbreak of A. baumannii is essential to finding the source of the infection, and that hygroscopic bandages may be a source of such outbreaks.
我们描述了新生儿重症监护病房（NICU）中鲍曼不动杆菌的一次暴发，以及我们为确定传播源和传播方式并识别高危人群所开展的调查。病例（感染婴儿）定义为在暴发期间入住NICU、具有败血症临床体征且分离出鲍曼不动杆菌的患者。在定植婴儿中，鲍曼不动杆菌是从无感染迹象的体表分离出来的。感染婴儿由不同的医疗团队进行隔离和治疗。从工作表面以及婴儿从产房到NICU的入院通道采集培养物。通过脉冲场凝胶电泳（PFGE）鉴定暴发菌株。9例病例和8例定植婴儿符合定义标准。病例在胎龄和诊断年龄方面比定植婴儿小，且出生体重较低（P<0.01）。暴发菌株仅从通气导管下方皮肤和脐导管上使用的吸湿绷带中分离出来。停止使用绷带后暴发结束。我们得出结论，在鲍曼不动杆菌暴发期间对环境进行快速彻底的调查对于找到感染源至关重要，并且吸湿绷带可能是此类暴发的一个源头。
