应用全基因组测序对呼吸重症监护病房耐碳青霉烯类鲍曼不动杆菌疑似暴发事件的调查
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R181.3+2

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山东省医药卫生科技发展基金资助项目(2018WS099);山东省重点研发计划(软科学)项目(2019RKB14038);中华预防医学会医院感染控制分会青年人才托举项目(2024)


A suspected outbreak of carbapenem-resistant Acinetobacter baumannii in respiratory intensive care unit: a survey by whole genome sequencing
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    摘要:

    目的 调查一起疑似耐碳青霉烯类鲍曼不动杆菌(CRAB)感染暴发事件的流行病学特征并分析原因,为医院感染预防与控制提供依据。方法 收集2024年5月某医院呼吸重症监护病房(RICU)的3例CRAB培养阳性患者的病例信息。对患者病房环境进行微生物学采样,并送检培养与鉴定,环境标本检出CRAB菌株与患者标本分离的CRAB菌株进行全基因组测序(WGS)。多部门联合制定并实施综合感染控制措施,并评估其效果。结果 3例患者的痰标本及其床旁鼠标标本均培养出CRAB,WGS检测显示2例患者的痰及床旁办公鼠标均检出ST2158、ST1791耐药基因。经综合判断,2例患者为医院感染,1例患者为定植,排除医院感染暴发。环境卫生学监测共采集24份环境标本,CRAB检出率为58.33%。床旁鼠标检出CRAB与患者痰标本分离的CRAB药敏结果一致。采取提高病房环境清洁消毒频率、加强手卫生执行力度以及加强科室人员管控与医院感染防控培训等措施后,医院感染得到有效控制。结论 此次RICU CRAB疑似暴发事件的可能传播途径为被污染的办公鼠标导致医护人员手部携带CRAB,继而因医护人员手卫生执行不力引起交叉感染。加强环境物体表面清洁消毒与医护人员手卫生管理是预防CRAB医院感染的关键措施。

    Abstract:

    Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) infection, and provide basis for healthcare-associated infection (HAI) prevention and control. Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit (RICU) of a hospital in May 2024 was collected. Microbiological sampling was performed in patients’ ward environment, and the specimens were cultured and strains were identified. CRAB strains detected from the environment and patients were performed whole genome sequencing (WGS). Multiple departments jointly formulated and implemented comprehensive infection control measures, and the effectiveness were evaluated. Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients. WGS detection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients. After comprehensive assessment, 2 patients were confirmed with HAI and 1 patient was confirmed with colonization, ruling out an outbreak of HAI. A total of 24 environmental specimens were taken for environmental hygiene monitoring, with a CRAB detection rate of 58.33%. CRAB detected from bedside mice and patients’ sputum specimen had consistent CRAB drug susceptibility testing results. After implementing measures such as increasing the frequency of cleaning and disinfection of ward environment, strengthening the implementation of hand hygiene, and enhancing the supervision of department personnel as well as HAI prevention and control training, HAI was effectively controlled. Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice, which caused healthcare workers carrying CRAB in their hands, leading to cross infection due to poor hand hygiene implementation of healthcare workers. Strengthening the cleaning and disinfection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

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仇先明,徐朋,董秀涛,等.应用全基因组测序对呼吸重症监护病房耐碳青霉烯类鲍曼不动杆菌疑似暴发事件的调查[J]. 中国感染控制杂志,2025,24(9):1300-1306. DOI:10.12138/j. issn.1671-9638.20252464.
QIU Xianming, XU Peng, DONG Xiutao, et al. A suspected outbreak of carbapenem-resistant Acinetobacter baumannii in respiratory intensive care unit: a survey by whole genome sequencing[J]. Chin J Infect Control, 2025,24(9):1300-1306. DOI:10.12138/j. issn.1671-9638.20252464.

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  • 收稿日期:2025-04-30
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  • 在线发布日期: 2025-09-23
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