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大规模持续地方性耐多药铜绿假单胞菌爆发:医院获得性感染的新流行病学情况。

A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition.

机构信息

IDIBELL, Infectious Diseases Service, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.

出版信息

BMC Infect Dis. 2011 Oct 13;11:272. doi: 10.1186/1471-2334-11-272.

Abstract

BACKGROUND

Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied.

METHODS

Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented.

RESULTS

Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more.

CONCLUSIONS

In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.

摘要

背景

最近有关多耐药铜绿假单胞菌(MRPA)引起的医院暴发的研究往往未能确定特定的环境储源。我们描述了一起由多耐药(MR)铜绿假单胞菌(PA)单一克隆引起的暴发,并评估了应用的监测程序和控制措施的效果。

方法

前瞻性地确定了携带 MRPA 分离株的患者(2006 年 1 月至 2008 年 5 月)。设计并实施了一种联合监测程序(环境调查和重症监护病房[ICU]中的主动监测计划)和感染控制策略(关闭 ICU 和泌尿科病房进行去污,严格遵守交叉传播预防协议以及限制 ICU 中碳青霉烯类药物使用的计划)。

结果

共发现 390 名患者。ICU 患者最多(22%),其次是泌尿科患者(18%)。环境监测发现,19 份非 ICU 环境样本中有 3 份(16%)和 63 份 ICU 样本中有 4 份(6%)为 MRPA 克隆株阳性。此外,主动监测发现 19%的患者是 MRPA 的粪便携带者。在干预 1(强化清洁程序)后,发病率趋势的显著变化为:-1.16 例/1000 患者日(95%CI -1.86 至-0.46;p = 0.003)和干预 2(广泛去污):-1.36 例/1000 患者日(95%CI -1.88 至-0.84;p <0.001)在泌尿科病房。此外,碳青霉烯类药物的使用限制在 ICU 中开始(2007 年 1 月),其用量从 190-170 DDD/1000 患者日(2006 年 10 月至 12 月)减少至 40-60 DDD/1000 患者日(2007 年 1 月至 4 月),从 2006 年 12 月的 3.1 例/1000 患者日降至 2007 年 5 月的 2.0 例/1000 患者日。2008 年初始碳青霉烯类药物的使用水平再次上升,MRPA 的发病率再次逐渐升高。

结论

在持续发生多耐药铜绿假单胞菌暴发的情况下,流行病学研究结果表明,患者可能是进一步环境污染和交叉传播的储源。尽管我们的控制方案未能成功结束暴发,但我们认为我们的经验为解决这一问题提供了有益的指导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/87af/3203071/171c85def22c/1471-2334-11-272-1.jpg

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