Bernards A T, Frénay H M, Lim B T, Hendriks W D, Dijkshoorn L, van Boven C P
Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.
Am J Infect Control. 1998 Dec;26(6):544-51. doi: 10.1053/ic.1998.v26.a84555.
The Dutch guideline on hospital policy for the prevention of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA) states that patients transferred from hospitals abroad must be placed in strict isolation immediately on admission to a hospital in the Netherlands. Three patients colonized with both MRSA and a multiresistant Acinetobacter were transferred from hospitals in Mediterranean countries to 3 different hospitals in the Netherlands. Despite isolation precautions, Acinetobacter spread in 2 of the 3 hospitals, whereas nosocomial spread of MRSA did not occur.
For outbreak analysis, the Acinetobacter isolates, identified as Acinetobacter baumannii by the use of amplified ribosomal DNA restriction analysis, were comparatively typed by 4 methods. Comparison of isolation measures in the hospitals was performed retrospectively.
In the 2 hospitals in which nosocomial spread of Acinetobacter occurred, most of the epidemiologically related isolates were indistinguishable from the index strains. In these 2 hospitals, isolation measures were in concordance with those recommended for the prevention of contact transmission. The precautions of the hospital in which no outbreak occurred included the prevention of airborne transmission.
Precautions recommended for multiresistant gram-negative organisms are insufficient for the prevention of nosocomial spread of multiresistant Acinetobacter. The airborne mode of spread of acinetobacters should be taken into account, and guidelines should be revised accordingly.
荷兰关于预防耐甲氧西林金黄色葡萄球菌（MRSA）医院内传播的医院政策指南规定，从国外医院转来的患者在入住荷兰医院时必须立即进行严格隔离。3例同时感染MRSA和多重耐药不动杆菌的患者从地中海国家的医院转至荷兰的3家不同医院。尽管采取了隔离预防措施，但不动杆菌仍在其中2家医院传播，而MRSA未发生医院内传播。
为进行暴发分析，使用扩增核糖体DNA限制性分析鉴定为鲍曼不动杆菌的不动杆菌分离株通过4种方法进行比较分型。对各医院的隔离措施进行回顾性比较。
在发生不动杆菌医院内传播的2家医院中，大多数与流行病学相关的分离株与指示菌株无法区分。在这2家医院中，隔离措施与推荐的预防接触传播的措施一致。未发生暴发的医院的预防措施包括预防空气传播。
推荐用于多重耐药革兰阴性菌的预防措施不足以预防多重耐药不动杆菌的医院内传播。应考虑不动杆菌的空气传播方式，并相应修订指南。
