Kong Yi, Liu Ting, Zhang Yanru, Wang Hui, Lin Hongyi
Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China.
Antimicrob Resist Infect Control. 2025 Apr 12;14(1):30. doi: 10.1186/s13756-025-01547-0.
During the Coronavirus Disease 2019 (COVID-19) epidemic, the strain on intensive care units (ICUs) has increased, which made them more vulnerable to the threat of multidrug-resistant organism (MDRO).
This study aims to investigate an outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) infection in a general adult ICU of a tertiary hospital in China during the COVID-19 epidemic and evaluate the effectiveness of intervention measures.
Demographic and clinical data of 37 patients were collected, and 230 environmental samples were collected. Whole genome sequencing (WGS) analysis was performed on clinical and environmental isolates. An evolutionary tree was constructed based on the WGS data. The infection control team implemented a bundle of MDRO interventions, including a termination of COVID-19 infection control measures and implementation of 'three-step' cleaning and disinfection method.
There were 37 patients found to have CRAB infection or colonization in the ICU from December 2022 to April 2023, of whom 35 were hospital-acquired. 12 CRAB isolates were obtained from the environment and medical equipment. Through WGS analysis, the CRAB strains from the medical environment and bronchoscopes were found to be highly homologous to those from patients' clinical specimens. This demonstrated that the infection outbreak was caused by the lack of MDRO prevention and control measures. Following intervention, the CRAB detection rate gradually declined, with no positive samples for CRAB found in the ICU environment or on bronchoscopes.
The infection control measures for COVID-19 conflicted with basic MDRO prevention and control strategies, likely contributing to the outbreak. Therefore, established infection prevention and control measures should be consistently followed, as they represent the most effective approach to preventing MDRO.
在2019冠状病毒病（COVID-19）疫情期间，重症监护病房（ICU）的压力增大，使其更容易受到多重耐药菌（MDRO）的威胁。
本研究旨在调查中国一家三级医院普通成人ICU在COVID-19疫情期间耐碳青霉烯鲍曼不动杆菌（CRAB）感染的暴发情况，并评估干预措施的效果。
收集37例患者的人口统计学和临床数据，采集230份环境样本。对临床和环境分离株进行全基因组测序（WGS）分析。基于WGS数据构建进化树。感染控制团队实施了一系列MDRO干预措施，包括终止COVID-19感染控制措施并实施“三步”清洁消毒方法。
2022年12月至2023年4月期间，ICU中有37例患者被发现感染或定植CRAB，其中35例为医院获得性感染。从环境和医疗设备中获得了12株CRAB分离株。通过WGS分析，发现来自医疗环境和支气管镜的CRAB菌株与患者临床标本中的菌株高度同源。这表明感染暴发是由于缺乏MDRO预防和控制措施所致。干预后，CRAB检出率逐渐下降，ICU环境或支气管镜上未发现CRAB阳性样本。
COVID-19的感染控制措施与基本的MDRO预防控制策略相冲突，可能导致了此次暴发。因此，应始终遵循既定的感染预防控制措施，因为它们是预防MDRO的最有效方法。
