某院一起耐碳青霉烯肠杆菌科细菌感染聚集性病例的调查与控制

Investigation and control of a cluster of carbapenem-resistant Enterobacteriaceae infections in a hospital

  • 摘要:
    目的 调查某院肾病科耐碳青霉烯肠杆菌科细菌感染事件,为医院感染防控提供参考。
    方法 对2025年6月19日-7月3日河南中医药大学第一附属医院肾病科发热患者进行流行病学调查和环境物表卫生学监测,针对风险因素采取有效的控制措施。
    结果 该病区在6月19日-7月3日出现8例发热患者,其中3例血培养检出碳青霉烯类耐药阴沟肠杆菌,2例检出碳青霉烯类耐药弗劳地枸橼酸杆菌。共采集输注液体、留置针、手、环境物表等标本110份,在输注液体、治疗室水池、治疗室挡水板等处检测出碳青霉烯类耐药弗劳地枸橼酸杆菌。针对流行病学调查和采样发现的风险因素采取综合控制措施结合强化清洁消毒,再次复查未检测出耐碳青霉烯肠杆菌科细菌。控制后5个月耐碳青霉烯肠杆菌科细菌检出数量和感染率下降,证实防控措施有效。
    结论 此次感染聚集性事件具体原因较复杂,通过大范围的采样,获取了部分传播链条,事件可能源于治疗室水池的耐碳青霉烯肠杆菌科细菌污染,继而通过环境和医务人员的手,导致无菌液体被污染。

     

    Abstract:
    OBJECTIVE  To investigate an incident of carbapenem-resistant Enterobacteriaceae (CRE) infections in the nephrology department of a hospital, and to provide references for the prevention and control of hospital-associated infections.
    METHODS  Epidemiological investigations and environmental hygiene monitoring were conducted on febrile patients in the nephrology department of the First Affiliated Hospital of Henan University of Chinese Medicine from Jun. 19 2025, to Jul. 3, 2025. Effective control measures were implemented based on identified risk factors.
    RESULTS  Eight febrile cases were reported in the ward between Jun. 19 and Jul. 3, with three cases tested positive for carbapenem-resistant Enterobacter cloacae and two cases for carbapenem-resistant Citrobacter freundii in blood cultures. A total of 110 samples were collected from infusion fluids, indwelling needles, hands and environmental surfaces. Carbapenem-resistant C. freundii was detected in infusion fluids, treatment room sinks and splash guards. Comprehensive control measures, including enhanced cleaning and disinfection, were adopted based on epidemiological findings. Subsequent re-examinations showed no further detection of CRE. Over five months post-intervention, both the detection rate and incidence of CRE declined, confirming the effectiveness of the measures.
    CONCLUSIONS  The cluster infection has complex causes. Extensive sampling partially traces the transmission chain, suggesting that contamination of treatment room sinks by CRE may have led to the spread via environmental surfaces and medical stuff's hands, ultimately contaminating sterile fluids.

     

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