重症监护病房患者耳念珠菌感染的调查与防控

Prevention and control of Candida auris infection in patients in intensive care unit

摘要:

目的 调查某院重症医学科（ICU）耳念珠菌患者感染/定植及环境污染情况，评价医院感染防控措施的效果。 方法 2022年6月某院ICU 1例长期住院患者血培养检出耳念珠菌，立即对该科住院患者不同体表部位及病区环境进行多次采样和细菌培养（频率为每间隔一周采样一次），并采用基质辅助激光解吸电离飞行时间质谱技术进行分析。对检出耳念珠菌的患者采取单间隔离、温水冲浴、洗必泰擦洗等措施，对病区环境采取擦洗、消毒等措施，采取主动筛查的方法评估防控措施效果。 结果 第一次主动筛查ICU 14例在院患者，其中8例患者检出耳念珠菌9株；首次检出耳念珠菌前一周内转出ICU的3例患者，均未检出耳念珠菌。第二次主动筛查ICU 13例在院患者，其中2例患者检出耳念珠菌2株；第三次主动筛查ICU 8例在院患者，仅在1例患者的腹股沟和腋下检出耳念珠菌，余患者筛查均为阴性；第四、五次主动筛查均未再检出耳念珠菌。环境监测结果显示，第一次主动筛查采集80份环境标本，分别在地面、医疗设备检出耳念珠菌6株，第二、三次筛查均未检出耳念珠菌。经采取综合防控措施，14例在院患者仅1例发生耳念珠菌败血症医院感染，其余患者均确定为耳念珠菌定植病例且后期均去定植。 结论 耳念珠菌易在病区内传播，但通过采取积极的医院感染防控措施，耳念珠菌感染仍可防可控。

Abstract:

Objective To investigate Candida auris(C. auris) infection/colonization in patients and environmental contamination in intensive care unit (ICU) of a hospital, and evaluate the effect of healthcare-associated infection(HAI) prevention and control measures. Methods In June 2022, C. auris was isolated from the blood culture of a long-term hospitalized patient in the ICU of a hospital. Multiple sampling and bacterial culture (once for every two weeks) were immediately performed on different sites of patient's body surface and ward environment. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was adopted for analysis. For patients with C. auris, measures such as single room isolation, warm water bathing, chlorhexidine scrubbing were taken. Ward environment was wiped and disinfected. The effect of prevention and control measures was evaluated by active screening. Results 14 patients in ICU were actively screened initially, 9 C. auris strains were isolated from 8 patients. C. auris was not detected in the 3 patients who were transferred out of ICU one week before the first detection of C. auris. 2 C. auris strains were isolated from 2 patients in the second active screening of 13 patients in ICU. In the third active screening of 8 patients in ICU, C. auris was found in the groin and armpit of 1 patient, other patients were all negative. The fourth and fifth active screening didn't detect C. auris. Environmental monitoring result showed that 6 C. auris strains were isolated from the ground and medical equipment in the first active screening of 80 environmental specimens. No C. auris was detected in the second and third screening. After taking comprehensive prevention and control measures, only 1 of the 14 patients suffered from healthcare-associated septicemia due to C. auris. The rest patients were confirmed with C. auris colonization and decolonized at the late stage. Conclusion C. auris is easy to spread in hospital wards, but can be prevented and controlled by taking active HAI prevention and control measures.