Valencia Raquel, Arroyo Luis A, Conde Manuel, Aldana Josefa M, Torres María-José, Fernández-Cuenca Felipe, Garnacho-Montero José, Cisneros José M, Ortíz Carlos, Pachón Jerónimo, Aznar Javier
Preventive Medicine and Public Health Services, Virgen del Rocío Hospital, Avenida Manuel Siurot s/n, Seville 41013, Spain.
Infect Control Hosp Epidemiol. 2009 Mar;30(3):257-63. doi: 10.1086/595977.
To describe what is, to our knowledge, the first nosocomial outbreak of infection with pan-drug-resistant (including colistin-resistant) Acinetobacter baumannii, to determine the risk factors associated with these types of infections, and to determine their clinical impact.
Nested case-control cohort study and a clinical-microbiological study.
A 1,521-bed tertiary care university hospital in Seville, Spain.
Case patients were inpatients who had a pan-drug-resistant A. baumannii isolate recovered from a clinical or surveillance sample obtained at least 48 hours after admission to an intensive care unit (ICU) during the time of the epidemic outbreak. Control patients were patients who were admitted to any of the "boxes" (ie, rooms that partition off a distinct area for a patient's bed and the equipment needed to care for the patient) of an ICU for at least 48 hours during the time of the epidemic outbreak.
All the clinical isolates had similar antibiotic susceptibility patterns (ie, they were resistant to all the antibiotics tested, including colistin), and, on the basis of repetitive extragenic palindromic-polymerase chain reaction, it was determined that all of them were of the same clone. The previous use of quinolones and glycopeptides and an ICU stay were associated with the acquisition of infection or colonization with pan-drug-resistant A. baumannii. To control this outbreak, we implemented the following multicomponent intervention program: the performance of environmental decontamination of the ICUs involved, an environmental survey, a revision of cleaning protocols, active surveillance for colonization with pan-drug-resistant A. baumannii, educational programs for the staff, and the display of posters that illustrate contact isolation measures and antimicrobial use recommendations.
We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.
据我们所知，描述首例泛耐药（包括耐黏菌素）鲍曼不动杆菌医院感染暴发情况，确定与这类感染相关的危险因素，并确定其临床影响。
巢式病例对照队列研究及临床微生物学研究。
西班牙塞维利亚一家拥有1521张床位的三级护理大学医院。
病例患者为在疫情暴发期间入住重症监护病房（ICU）至少48小时后，从临床或监测样本中分离出泛耐药鲍曼不动杆菌的住院患者。对照患者为在疫情暴发期间入住ICU任何“隔间”（即划分出用于放置患者病床及护理所需设备的独立区域的房间）至少48小时的患者。
所有临床分离株具有相似的抗生素敏感性模式（即对所有测试抗生素包括黏菌素均耐药），基于重复基因外回文序列聚合酶链反应确定所有分离株均为同一克隆。先前使用喹诺酮类和糖肽类药物以及入住ICU与获得泛耐药鲍曼不动杆菌感染或定植相关。为控制此次暴发，我们实施了以下多组分干预方案：对相关ICU进行环境去污、环境调查、修订清洁规程、对泛耐药鲍曼不动杆菌定植进行主动监测、对工作人员开展教育项目以及张贴说明接触隔离措施和抗菌药物使用建议的海报。
我们未能确定这些感染病例的共同来源，但已证明所采取的措施在控制暴发方面有效。
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