Herruzo R, de la Cruz J, Fernández-Aceñero M J, Garcia-Caballero J
Department of Preventive Medicine UAM, Autonoma University of Madrid and Hospital La Paz, C/Arzobispo Morcillo, 4, 28029 Madrid, Spain.
Burns. 2004 Aug;30(5):419-23. doi: 10.1016/j.burns.2004.01.008.
Acinetobacter baumanii is generally a highly antibiotic resistant micro-organism that can be easily transmitted between inpatients of ICUs. We report two consecutive outbreaks of A. baumanii in a burn ICU.
All patients with ICU-stay greater than 2 days were subject to a strict epidemiological surveillance after admission, recording age, sex, TSBA, etc. and follow-up data such as antibiotherapy, instrumentation, infections, etc. We also monitored the microbial flora evolution and their resistance to antibiotic by weekly cultures of pharynx, rectum, skin (healthy and burned), etc. Because of an "epidemic" microorganism, infection control procedures, were increased. We studied the colonization by other prevalent microorganisms: MR-S. aureus and Pseudomonas aeruginosa.
Seventy-two burn patients were followed in 1 year. Only 4.1% were infected at some site by A. baumanii, but 1/3 of patients were colonized by this microorganism, distributed in two outbreaks, one in the first trimester, after admission in the Unit of two non-burned and colonized patients (from another ICU). The second epidemic began in July and probably was due to transitory colonization of skin or fomites by health personnel working in both ICUs. All the isolates (from both ICUs) of A. baumanii were identical by PFGE. The length of hospital stay was the main risk factor for colonization. P. aeruginosa and MR-S. aureus showed a tendency to be endemo-epidemic at all times.
Our cross colonization control measures showed a limited efficacy our burn patients. Therefore, we must impede the introduction to burn ICUs of epidemic microorganisms by colonized patients or heath personnel by restriction of admission of A. baumanii colonized patients from other ICUs (if the treatment can be administered in this ICU) and by strict disinfection/antiseptic procedures.
鲍曼不动杆菌通常是一种高度耐药的微生物，很容易在重症监护病房（ICU）的住院患者之间传播。我们报告了烧伤ICU中连续两次鲍曼不动杆菌暴发事件。
所有入住ICU超过2天的患者在入院后均接受严格的流行病学监测，记录年龄、性别、创伤严重程度评分（TSBA）等，以及后续数据，如抗生素治疗、器械使用、感染情况等。我们还通过每周对咽部、直肠、皮肤（健康和烧伤部位）等进行培养，监测微生物菌群的演变及其对抗生素的耐药性。由于出现了一种“流行”微生物，感染控制措施得到了加强。我们研究了其他常见微生物的定植情况：耐甲氧西林金黄色葡萄球菌（MR-S. aureus）和铜绿假单胞菌。
1年内对72名烧伤患者进行了随访。只有4.1%的患者在某个部位被鲍曼不动杆菌感染，但1/3的患者被这种微生物定植，分布在两次暴发事件中，一次在第一季度，是在两名非烧伤且已定植的患者（来自另一个ICU）入住该科室后发生的。第二次疫情始于7月，可能是由于两个ICU的医护人员导致皮肤或污染物的短暂定植。通过脉冲场凝胶电泳（PFGE）分析，所有分离株（来自两个ICU）的鲍曼不动杆菌均相同。住院时间是定植的主要危险因素。铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌始终呈现地方性流行趋势。
我们的交叉定植控制措施对烧伤患者显示出有限的效果。因此，我们必须通过限制来自其他ICU的鲍曼不动杆菌定植患者入院（如果可以在本ICU进行治疗）以及严格的消毒/防腐程序，防止定植患者或医护人员将流行微生物引入烧伤ICU。
