Woon Jia Jie, Ahmad Kamar Azanna, Teh Cindy Shuan Ju, Idris Nuryana, Zhazali Rosliza, Saaibon Suzana, Basauhra Singh Harvinderjit Kaur, Charanjeet Singh Jasreena Kaur Gill, Kamarulzaman Adeeba, Ponnampalavanar Sasheela
Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur 50603, Malaysia.
Department of Paediatrics, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur 50603, Malaysia.
Microorganisms. 2023 Apr 20;11(4):1073. doi: 10.3390/microorganisms11041073.
The present study describes an epidemiological investigation into a carbapenem-resistant (CRAB) outbreak, which had occurred in a neonatal intensive care unit (NICU), and the subsequent strengthening of infection control interventions. Upon the onset of the outbreak, existing infection control interventions were reviewed, and a set of containment measures were instituted. All CRAB isolates were characterized in terms of antimicrobial susceptibility testing and their genetic relatedness. The investigation process identified gaps within the NICU's existing infection control measures, which had likely resulted in the outbreak. CRAB was isolated from nine preterm infants: five colonized and four infected. All five colonized patients were discharged well. However, three out of four of the infected infants died. Outbreak investigation and genomic subtyping of environmental swabs revealed that mini syringe drivers shared between patients and a sink in the milk preparation room had served as CRAB reservoirs with possible transmission via the hands of healthcare workers. Implementation of immediate actions such as reinforcement of hand hygiene practices, intensified environmental cleaning, geographical cohorting, reviewing of milk handling practices and sink management protocol had resulted in no further CRAB isolation. The CRAB outbreak in the NICU underlines the importance of consistent compliance with infection-control interventions. Integration of epidemiological and microbiological data, together with comprehensive preventive measures, successfully brought the outbreak to a halt.
本研究描述了对新生儿重症监护病房（NICU）发生的耐碳青霉烯类鲍曼不动杆菌（CRAB）暴发的流行病学调查，以及随后加强感染控制干预措施的情况。在暴发开始时，对现有的感染控制干预措施进行了审查，并制定了一套控制措施。对所有CRAB分离株进行了药敏试验及其基因相关性分析。调查过程发现了NICU现有感染控制措施中的漏洞，这些漏洞可能导致了暴发。从9名早产儿中分离出CRAB：5名定植，4名感染。所有5名定植患者均顺利出院。然而，4名感染婴儿中有3名死亡。对环境拭子进行的暴发调查和基因组分型显示，患者共用的微量注射器驱动器和配奶室的一个水槽充当了CRAB的储存源，可能通过医护人员的手传播。立即采取加强手卫生措施、强化环境清洁、地理分组、审查牛奶处理操作和水槽管理规程等行动后，未再分离出CRAB。NICU的CRAB暴发凸显了始终如一地遵守感染控制干预措施的重要性。将流行病学和微生物学数据与全面的预防措施相结合，成功地遏制了暴发。
