Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
Am J Infect Control. 2018 Aug;46(8):893-898. doi: 10.1016/j.ajic.2018.01.027. Epub 2018 Mar 16.
Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care-associated outbreak investigations at an academic hospital during a 5-year period.
Health care-associated outbreak investigations at an academic hospital (2012-2016) were retrospectively reviewed through data on comprehensive hospital-wide surveillance and pulsed-field gel electrophoresis (PFGE) analysis.
Fifty-one health care-associated outbreaks (annual range, 8-15), including 26 (51%) outbreaks in intensive care units (ICUs), and 263 infected-colonized patients involved in these outbreaks were identified. The frequency of pathogens varied by affected location, specifically multidrug-resistant organisms (20/26 outbreaks, 77% in ICUs vs 2/25 outbreaks, 8% in non-ICUs; P < .0001) and gastroenteritis because of Clostridium difficile, norovirus, or adenovirus (1/26 outbreaks, 4% in ICUs vs 17/25 outbreaks, 68% in non-ICUs; P < .0001). Outbreaks occurred in approximately one-third of all units (37%) with some repeated instances of the same pathogens. Of 16 outbreaks caused by a bacterial pathogen evaluated by PFGE, 12 (75%) included some indistinguishable strains, suggesting person-to-person transmission or a common source.
This study demonstrated epidemiologic characteristics of multiple outbreaks between ICUs and non-ICUs and the value of molecular typing in understanding the epidemiology of health care-associated outbreaks.
医疗机构内常报告单一暴发事件，但一段时间内医院内暴发的频率尚未描述。我们研究了在 5 年期间一所学术医院所有与医疗保健相关的暴发调查的流行病学特征。
通过对全面医院范围监测和脉冲场凝胶电泳（PFGE）分析的数据，回顾性审查了一所学术医院（2012-2016 年）的与医疗保健相关的暴发调查。
确定了 51 起与医疗保健相关的暴发事件（年范围为 8-15 起），其中包括 26 起（51%）发生在重症监护病房（ICU）的暴发，以及涉及这些暴发的 263 例感染定植患者。病原体的频率因受影响的位置而异，具体为多药耐药菌（26 起暴发中有 20 起，77%在 ICU 中，25 起非 ICU 暴发中有 2 起，8%；P<0.0001）和与艰难梭菌、诺如病毒或腺病毒相关的胃肠炎（26 起暴发中有 1 起，4%在 ICU 中，25 起非 ICU 暴发中有 17 起，68%；P<0.0001）。暴发发生在大约三分之一的科室（37%），其中一些相同病原体出现了重复的情况。在 16 起由 PFGE 评估的细菌病原体引起的暴发中，有 12 起（75%）包含一些无法区分的菌株，表明人与人之间的传播或共同来源。
本研究展示了 ICU 和非 ICU 之间的多起暴发的流行病学特征，以及分子分型在理解与医疗保健相关的暴发的流行病学中的价值。
