Chan Pei-Chun, Huang Li-Min, Lin Hui-Chi, Chang Luan-Yin, Chen Mei-Ling, Lu Chun-Yi, Lee Ping-Ing, Chen Jung-Min, Lee Chin-Yun, Pan Hui-Jui, Wang Jann-Tay, Chang Shan-Chwen, Chen Yee-Chun
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Infect Control Hosp Epidemiol. 2007 Apr;28(4):423-9. doi: 10.1086/513120. Epub 2007 Mar 16.
To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR) Acinetobacter baumannii in a 7-day-old neonate who developed PDR A. baumannii bacteremia that was presumed to be the iceberg of a potential outbreak.
Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.
A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.
Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDR A. baumannii isolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.
One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDR A. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDR A. baumannii in 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDR A. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.
In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDR A. baumannii was suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDR A. baumannii.
调查一名7日龄新生儿中泛耐药鲍曼不动杆菌的潜在储存宿主及传播方式，该新生儿发生了泛耐药鲍曼不动杆菌菌血症，推测这可能是潜在暴发的冰山一角。
基于全院范围医院感染前瞻性监测计划的暴发调查。
台湾一所拥有2200张床位的大型教学医院中的一间设有24张床位的新生儿重症监护病房，该病房为本院出生的危重新生儿以及从其他医院转诊来的新生儿提供护理。
对33名医护人员的手部样本及40份环境样本进行培养。对新生儿重症监护病房入院时及每2周直至出院的肛门拭子标本和痰液样本进行监测培养。将泛耐药鲍曼不动杆菌分离株定义为除多黏菌素B外对所有目前可用的全身抗菌药物均耐药的分离株，并通过脉冲场凝胶电泳进行分析。控制措施包括实施接触隔离、加强手卫生依从性、护士分组以及环境清洁。
一份环境样本培养出泛耐药鲍曼不动杆菌，医护人员手部样本培养均为阴性。阳性培养结果来自于索引患者使用的一根通气管样本。在接下来的2个月中，主动监测在另外8名新生儿中发现了泛耐药鲍曼不动杆菌，其中7株分离株具有相同的电核型。在9名定植或感染泛耐药鲍曼不动杆菌的新生儿中，1名死于无关疾病。加强感染控制措施使手卫生规范的依从率达到100%。暴发得到控制，且未影响患者护理。
在无环境污染的情况下，怀疑照顾定植或感染泛耐药鲍曼不动杆菌新生儿的人员手部短暂携带是传播方式。警惕、及时干预以及严格遵守手卫生规范是成功控制此次暴发的关键因素。主动监测似乎是识别泛耐药鲍曼不动杆菌潜在传播者和储存宿主的有效措施。
