4起耐药鲍曼不动杆菌医院感染聚集性病例调查

Investigation on four nosocomial infection cluster cases caused by drugresistant Acinetobacter baumannii

摘要:

目的探讨耐药鲍曼不动杆菌（DRAb）引起医院感染聚集性病例(NICC)的原因。方法对4起DRAb NICC的临床资料及流行病学调查结果进行分析和统计学描述。结果4起14例DRAb NICC均发生在气候炎热季节,分布于重症监护室（ICU）；其中危重患者10例（71.43%），老年患者（＞65岁）6例（42.86%）；入住ICU时间的中位数为8 d；发生DRAb感染前局部生理屏障均受到破坏。12例（85.71%）为肺部感染(呼吸机相关性肺炎占 64.29%)；11例（78.57%）为泛耐药Ab感染。发生医院感染前，9例（64.29%）患者有长期联合使用抗菌药物史；感染源2起是输入性的医院感染。结论DRAb NICC的发生与患者的易感性、隔离与消毒、病区医院感染监控、抗菌药物使用以及Ab的生物学特性等有关。

Abstract:

ObjectiveTo evaluate the causes of nosocomial infection cluster cases(NICC) caused by drugresistant Acinetobacter baumannii(DRAb). MethodsClinical data and epidemiological survey results of 4 NICC were analyzed and described by statistics.ResultsFourteen cases in 4  DRAb NICC occurred at ICU  in hot weather season; 10(71.43%) were critical patients; 6(42.86%) were older patients (>65 years); the median time of ICU stay were 8 days; the local physiological barriers of all cases were destroyed before developing DRAb infection.12 cases (85.71%) developed pulmonary infection (64.29% for ventilatorassociated pneumonia); 11(78.57%) were infected with pandrug resistant Acinetobacter baumannii (PDRAb). Nine patients (64.29%)  had a history of longterm use of combination  antimicrobial agents before developing NI; 2 NICC  were afferent NI.ConclusionThe occurrence  of ICU DRAb  NICC is  associated with susceptibility of patients, isolation and disinfection, ward NI surveillance, use of antimicrobial agents, and biological characteristics of  Acinetobacter baumannii