王黎明,唐定豪,江显萍,杨永鑫,董群雁,杨玉红,吴志平
WANG Liming,TANG Dinghao,JIANG Xianping,YANG Yongxin,DONG Qunyan,YANG Yuhong,WU Zhiping

• 1:黔南州人民医院医院感染管理科
• 2:黔南州人民医院神经内科
• 3:黔南州人民医院泌尿外科

摘要(Abstract)：

目的 探讨神经外科重症监护病房（NSICU）发生耐碳青霉烯类肺炎克雷伯菌（CRKP）院内聚集性事件的流行特征及处理效果。方法 选取贵州省某三甲医院NSICU患者180例为研究对象，收集整改前CRKP医院感染患者流行病学资料，采集NSICU可疑物体表面及12名医务人员操作中的手采样标本进行病原菌培养及药敏试验，对医院感染聚集和医院感染进行判断；采用细菌基因组法对标本进行CRKP多位点序列分型（MLST），现场观察科室人员多重耐药防控措施执行情况后分析可能的传染源及传播途径；于整改后采取针对性CRKP感染防控整改措施并进行整改前后效果评价。结果 整改前NSICU医院感染发病率为3.89%，较前年同期上升2.45%，呈CRKP院感聚集趋势；分别在病床护栏、输液泵、医疗废物桶盖检出3株CRKP;MLST结果显示检出ST11和ST423两种型别，以ST11为主（80%）；整改前科室存在医务人员消毒隔离措施落实不到位、医疗废物收集处置方法不规范等问题；采取整改措施后CRKP医院感染率降低到0.63%。结论 NSICU检出的CRKP存在克隆传播，采取针对性防控措施，可有效阻断CRKP传播，减少医院感染发生。
Objective To investigate the epidemiological characteristics and treatment effect of nosocomial clustering events of carbapenem-resistantKlebsiella pneumoniae(CRKP) in neurosurgical intensive care unit( NSICU).Methods A total of 180 NSICU patients in a first-class hospital in Guizhou Province were selected as research object, and epidemiological data of CRKP patients with nosocomial infection before rectification was collected. The surface of suspected NSICU objects and hand samples of 12 medical staff were collected for pathogenic bacteria culture and drug susceptibility testing, and for the judgment of nosocomial infection clustering and nosocomial infection. CRKP multilocus sequence typing(MLST) was performed by using the bacterial genome method. After the on-thespot observation of the implementation of multi-drug resistance prevention and control measures of the medical staff, the possible sources of infection and transmission routes were analyzed. After rectification, targeted rectification measures for prevention and control of CRKP infection were taken and the effects before and after rectification were evaluated.Results Before rectification, the incidence of nosocomial infection in NSICU was 3. 89%, which was 2. 45% higher than that in the previous year, showing a trend of CRKP nosocomial infection clustering. 3 strains of CRKP were detected in the bed guardrail, infusion pump and medical waste bucket lid; mLST results showed that ST11 and ST423 were detected, mainly ST11(80%). Before the rectification, there were some problems in the department such as the inadequate implementation of disinfection and isolation measures for medical staff, and the collection and disposal methods of medical waste were not standardized. After taking rectification measures, the CRKP nosocomial infection rate decreased to0. 63%.Conclusion The CRKP detected in the NSICU has clonal transmission, and targeted preventive and control measures can effectively block the transmission of CRKP and reduce the occurrence of nosocomial infections.

关键词(KeyWords)： 肺炎克雷伯菌;耐碳青霉烯;医院感染;聚集;调查;控制
Klebsiella pneumoniae (KP);carbapenem-resisant;nosocomial infection;clustering;investigation;control

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫健委科研基金项目（gzwjkj2019-1-047）;; 贵州省黔南州科技局科研基金项目（黔南科合社字[2018]55）;; 贵州省黔南民族医专2018年度校科研基金项目（QNYZ201844）

作者(Author): 王黎明,唐定豪,江显萍,杨永鑫,董群雁,杨玉红,吴志平
WANG Liming,TANG Dinghao,JIANG Xianping,YANG Yongxin,DONG Qunyan,YANG Yuhong,WU Zhiping

DOI: 10.19367/j.cnki.2096-8388.2022.06.011

参考文献(References)：

• [1]陈丽琴，韩永慧，李伟杰，等．某儿童医院PICU一起疑似CRKP医院感染暴发的流行病学调查[J]．中国感染控制杂志，2020,19(12):1108-1113.
• [2]李向欣，何秀娟，程小龙．耐碳青霉烯类肺炎克雷伯菌在医院获得性肺炎中的流行病学与耐药性分析[J]．中国病原生物学杂志，2019,14(10):1223-1227.
• [3]宋婷，俞蕙．耐碳青霉烯类肺炎克雷伯杆菌的感染现状及治疗进展[J]．中华儿科杂志，2016,54(3):234-236.
• [4] WANG Z,QIN R R,HUANG L,et al.Klebsiella pneumoniaerisk factors for Carbapenem-resistant infection and mortality of infection[J]. Chin Med J(Engl), 2018, 131:56-62.
• [5]刘银梅，吴晓松，杨惠英，等．耐碳青霉烯类肺炎克雷伯菌呼吸机相关肺炎发病及预后危险因素[J]．中华医院感染学杂志，2020,30(22):3378-3383.
• [6]胡付品，郭燕，朱德妹，等．2018年CHINET中国细菌耐药性监测[J]．中国感染与化疗杂志，2020,20(1):1-10.
• [7]龙华婧，邱芳华，刘道利，等．中国2017—2019年耐碳青霉烯类肺炎克雷伯菌耐药基因及流行克隆特征[J]．中国感染控制杂志，2021,20(11):1008-1015.
• [8]谭莉，徐蓉，凃敏，等．一起ICU耐碳青霉烯类肺炎克雷伯菌感染暴发调查[J]．中华医院感染学杂志，2020,30(19):2949-2953.
• [9] ZHU J Y,LI Q,LI X X,et al. Successful control of the first carbapenem-resistantKlebsiella pneumoniaeoutbreak in a Chinese hospital 2017-2019[J]. Antimicrob Resist Infect Control,2020,9:91.
• [10]中华人民共和国卫生部．医院感染诊断标准（试行）[J]．中华医学杂志，2001,81(5):314-320.
• [11]李笑蕾，倪明．医药洁净室及相关受控环境标准研究[J]．中国药事，2020,34(10):1165-1170.
• [12]尚红，王毓三，申子瑜．全国临床检验操作规程[M]. 4版．北京：人民卫生出版社，2015:684-700.
• [13] SAHU C,JAIN V,MISHRA P, et al. Escherichia coli clinical and laboratory standards institute versus European committee for antimicrobial susceptibility testing guidelines for interpretation of carbapenem antimicrobial susceptibility results for in urinary tract infection(UTI)[J]. J Lab Physicians, 2018, 10:289-293.
• [14]中华人民共和国国家卫生和计划生育委员会．医院感染暴发控制南：WS/T 524-2016[S]．北京：中华人民共和国国家卫生和计划生育委员会，2017.
• [15]赵艳春，袁翠，李双玲，等．一起ICU耐碳青霉烯类鲍氏不动杆菌聚集性病例调查[J]．中华医院感染学杂志，2020,30(22):3389-3393.
• [16]章明明，宋微微，柯有韬，等．神经外科耐碳青霉烯类肺炎克雷伯菌感染暴发调查与控制[J]．中国感染控制杂志，2019,18(4):353-357.
• [17]沈翠芬，张晓祥，辛少军，等．耐碳青霉烯类肺炎克雷伯菌的临床分布及耐药性分析[J]．中国卫生检验杂志，2020,30(23):2838-2840.
• [18]张莉，陈媛，王义俊，等．重症监护室患者耐碳青霉烯类肺炎克雷伯菌感染危险因素分析[J]．中国医院药学杂志，2020,40(23):2459-2463.
• [19]刘洁，杨晶，高立芳，等．耐碳青霉烯类肺炎克雷伯菌的耐药性及危险因素分析[J]．中华医院感染学杂志，2020,30(8):1223-1227.
• [20]陈娅，陈鸿，刘瑶，等．耐碳青霉烯类肺炎克雷伯菌医院感染的危险因素分析[J]．中华医院感染学杂志，2019,29(8):1131-1135.
• [21]DA S K,MACIEL W G,SACCHI F P,et al. Risk factors for KPC-producing Klebsiella pneumoniae:watch out for surgery[J]. J Med Microbiol,2016,65(6):547-553.
• [22]PAN H Y,LOU Y L,ZENG L Y,et al. Infections caused by Carbapenemase-ProducingKlebsiella pneumoniae:microbiological characteristics and risk factors[J]. Microb Drug Resist,2019,25:287-296.
• [23]刘如安．耐碳青霉烯类肺炎克雷伯菌下呼吸道感染患者临床特征及危险因素分析[J]．中南医学科学杂志，2020,48(2):141-145.
• [24]施毅．中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南（2018年版）[J]．中华结核和呼吸杂志，2018,41(4):255-280.
• [25]何红，黄紫嫣，陶晓燕，等．耐碳青霉烯类肺炎克雷伯菌产酶耐药机制及同源性分析[J]．中华医院感染学杂志，2021,31(3):326-331.
• [26]李玉雪，郭玉梅．耐碳青霉烯类肺炎克雷伯菌的耐药表型及同源性分析[J]．中华医院感染学杂志，2018,28(17):2572-2575.
• [27]龚林，刘小丽，许慧琼，等．耐碳青霉烯类肺炎克雷伯菌分子流行病学研究[J]．中国感染控制杂志，2019,18(7):643-647.

文章评论(Comment)：