骨科手术后血流感染疑似暴发事件的调查

Suspected outbreak of blood stream infection after orthopedic operation

摘要:

目的 对某医院骨科患者手术后发生疑似血流感染暴发事件进行流行病学调查，为医院感染防治策略提供参考依据。 方法 收集该院2020年7月16—18日手术后发生寒战、高热患者的流行病学资料，对患者及其周围环境和物品检出菌进行药敏测试，采用多位点序列分型（MLST）方法进行同源性分析。 结果 共发现骨科4例阴沟肠杆菌所致医院获得性血流感染病例，发病时间集中，病原菌药敏结果相似。共采集61份环境标本，有26份检出细菌，阳性率42.62%。8份批号为2020071**的等渗冲洗液均检出阴沟肠杆菌，2份批号为2020061**的等渗冲洗液均未检出细菌。12株阴沟肠杆菌的MLST结果是ST1190型1株、ST531型2株、ST547型2株、ST290型1株、ST777型3株、ST422型1株、ST1032型1株、ST717型1株，存在同种同源的阴沟肠杆菌。 结论 该院骨科患者发生手术后血流感染疑似暴发事件，可能与手术所用的新批次等渗冲洗液在运输或生产过程中被污染有关。医院要加强一次性外来医疗用品的监管，定期抽检无菌物品，检测合格才予以放行，降低外源性感染风险，防止相关血流感染事件的暴发。

Abstract:

Objective To perform epidemiological investigate on the suspected outbreak of blood stream infection (BSI) in orthopaedic patients after operation in a hospital, so as to provide reference for the prevention and control strategy of healthcare-associated infection (HAI). Methods Epidemiological data of patients with chill and high fever after operation in this hospital from July 16 to 18, 2020 were collected, bacteria isolated from patients, as well as their surroundings and articles were performed antimicrobial susceptibility testing, multilocus sequence typing (MLST) was used for homology analysis. Results A total of 4 cases of healthcare-associated blood stream infection caused by Enterobacter cloacae (E. cloacae) were found in department of orthopedics, the onset time was concentrated and antimicrobial susceptibility testing results of pathogens were similar. A total of 61 environmental specimens were collected, 26 of which were isolated bacteria, with a positive rate of 42.62%, 8 isoosmotic rinsing solution with batch number of 2020071* * were isolated E. cloacae, 2 isoosmotic rinsing solution with batch number of 2020061* * were not isolated E. cloacae. MLST results of 12 strains of E. cloacae were ST1190 (1 strain), ST531 (2 strains), ST547 (2 strains), ST290 (1 strain), ST777 (3 strains), ST422 (1 strain), ST1032 (1 strain) and ST717 (1 strain), there are homologous E. cloacae. Conclusion The suspected outbreak of post-operative BSI in orthopaedic patients in this hospital may be related to the contamination of a new batch of isoosmotic rinsing solution used for operation during transportation or production. Hospitals should strengthen the supervision of disposable foreign medical supplies, regularly sample sterile items, and use them only after passing the test, so as to reduce the risk of exogenous infection and prevent the outbreak of BSI events.