一起导管相关黏质沙雷菌血流感染暴发 
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许青霞

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R181.3+2

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河南省科技厅重点科技攻关项目(112102310256)


An outbreak of catheterrelated bloodstream infection with Serratia marcescens
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    摘要:

    目的调查某院乳腺外科一起由黏质沙雷菌引起导管相关血流感染(CRBSI)暴发的原因,为预防和控制医院感染提供依据。方法采用临床资料调查和现场采样相结合的方法,对此次医院感染暴发进行流行病学调查。结果乳腺外科2014年1月2—8日连续发生9例CRBSI。其中4例患者导管尖端和血液标本中均培养出黏质沙雷菌,5例患者导管尖端培养出黏质沙雷菌。检出的黏质沙雷菌耐药谱基本相同;仅头孢西丁药敏结果有差异,其中7株为中介,1株耐药,1株敏感,但相同患者导管尖端和血液标本中检出的黏质沙雷菌药敏结果完全相同。医务人员手、治疗室门把手、治疗车表面各检出1株黏质沙雷菌,其耐药谱与血培养菌株基本一致。9例感染患者经拔除导管,使用抗菌药物治疗后,感染得到有效控制;病区经严格消毒后,均未检出黏质沙雷菌,未再出现新发感染病例。结论乳腺外科环境污染,医务人员手卫生不规范,导管留置时间长等是此次感染暴发的主要原因。应加强医务人员手卫生依从性,重视环境及物体表面的消毒,有效预防和控制医院感染。

    Abstract:

    ObjectiveTo investigate the causes of an outbreak of Serratia marcescens (S. marcescens) catheterrelated bloodstream infection(CRBSI) in a breast surgery department,and provide  basis for the prevention and control of healthcareassociated infection(HAI). MethodsEpidemiological investigation was performed by analyzing clinical data and sampling. ResultsNine cases of CRBSI occurred in a breast surgery department  on January 2—8,2014. Four  patients isolated S. marcescens from their catheter tips and blood culture specimens, and 5 patients only isolated S. marcescens from their catheter tips.The resistant spectrum of S. marcescens were basically the same, but cefoxitin susceptibility results were different, 7 strains were  intermediate, 1 resistant, and 1 sensitive, antimicrobial susceptibility testing results of S. marcescens from catheter tips and blood culture specimens of the identical patients were the same. S. marcescens were detected from the hands of medical staff(n=1),door handle of the therapeutic room (n=1), and surface of the treatment trolley (n=1), the resistant spectrum were consistent with that of bacteria from blood culture. All infected patients were effectively controlled after catheter removal and antimicrobial use. Wards were not detected S. marcescens and no new infection occurred again after strict disinfection. ConclusionThe main causes of the outbreak are contamination of environment of breast surgery department,nonstandardized hand hygiene,long time catheterization. Medical staff should strengthen hand hygiene compliance,pay attention to disinfection of environment and surface,effectively prevent and control HAI.

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潘军,许青霞,肖伟强,等.一起导管相关黏质沙雷菌血流感染暴发 [J]. 中国感染控制杂志,2014,13(10):592-595. DOI:10.3969/j. issn.1671-9638.2014.10.004.
PAN Jun, XU Qingxia, XIAO Weiqiang, et al. An outbreak of catheterrelated bloodstream infection with Serratia marcescens[J]. Chin J Infect Control, 2014,13(10):592-595. DOI:10.3969/j. issn.1671-9638.2014.10.004.

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  • 收稿日期:2014-05-22
  • 最后修改日期:2014-07-28
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  • 在线发布日期: 2014-10-30
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