Duman Yucel, Ersoy Yasemin, Gursoy Nafia Canan, Altunisik Toplu Sibel, Otlu Baris
Medical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey.
Infections Disease Medical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey.
Iran J Basic Med Sci. 2020 Jan;23(1):46-50. doi: 10.22038/IJBMS.2019.35269.8400.
Infections due to carbapenemase-producing are associated with high morbidity and mortality. In this study, we report a hospital outbreak due to co-producing OXA-48 and NDM-1 clone. The aim of the study is to investigate the clonal relationship of strains, risk factors of outbreak and infection control measures.
Once an outbreak was suspected at the end of December 2017 in our intensive care unit (ICU), carbapenem resistance identified in patients' specimens. An outbreak analysis was begun to determine the risk factors and dissemination of the cases. A case-control study was conducted to determine the risk factors. To control the outbreak; tight contact prevention, good clean-up the medical devices and hospital environment, were done. Staff training programs such as hand hygiene, disinfection, wearing aprons, good cleaning were created. Carbapenem resistance genes determined by PCR. Clonal relationships of strains investigated by PFGE.
We investigate 21 carbapenem-resistant strains. Nine of them were found co-produced NDM-1 and OXA-48, 11 strains produced OXA-48, and one strain produced NDM-1. Seven strains of co-producing NDM-1 and OXA-48 were found clonally related with PFGE. We could not determine any risk factor except rectal colonization in the case-control study.
The interventions that successfully controlled this outbreak were hand hygiene, tight contact prevention, good clean-up of the hospital environment and medical devices. As a result, we believe that it would be beneficial to take infection control measures to prevent the spread of these strains to the community and hospital settings.
产碳青霉烯酶的感染与高发病率和死亡率相关。在本研究中，我们报告了一起由同时产生OXA - 48和NDM - 1的克隆菌株引起的医院暴发。本研究的目的是调查菌株的克隆关系、暴发的危险因素及感染控制措施。
2017年12月底，我们的重症监护病房（ICU）怀疑暴发疫情，在患者标本中鉴定出碳青霉烯耐药菌。开始进行暴发分析以确定病例的危险因素和传播情况。开展病例对照研究以确定危险因素。为控制暴发，采取了严格的接触预防措施，对医疗器械和医院环境进行了良好的清洁，并制定了诸如手卫生、消毒、穿围裙、良好清洁等员工培训计划。通过聚合酶链反应（PCR）确定碳青霉烯耐药基因。通过脉冲场凝胶电泳（PFGE）研究菌株的克隆关系。
我们调查了21株耐碳青霉烯菌。其中9株被发现同时产生NDM - 1和OXA - 48，11株产生OXA - 48，1株产生NDM - 1。发现7株同时产生NDM - 1和OXA - 48的菌株通过PFGE呈克隆相关。在病例对照研究中，除直肠定植外，我们未确定任何危险因素。
成功控制此次暴发的干预措施包括手卫生、严格的接触预防、对医院环境和医疗器械的良好清洁。因此，我们认为采取感染控制措施以防止这些菌株在社区和医院环境中传播将是有益的。
