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成人急診觀察室Acinetobacter baumannii群聚感染及移生事件之疫調及處理經驗

Epidemiological Study of a Cluster of Acinetobacter baumannii Infection/Colonization at an Observation Room of Emergency Department in a Medical Center

摘要


南部某醫學中心感染管制組於2005年3月3日常規院內感染監視發現,一名由急診第五觀察室留觀5天後轉入急診加護病房之病人,隔日送驗之痰液培養出多重抗藥性鮑氏不動桿菌(multidrug-resistant Acinetobacter baumannii (MDR-A. baumannii),爲釐清感染來源,回溯調閱2005年1-2月資料,追查曾經住過急診第五觀察室的病人,其痰液檢驗出MDR-A. baumannii, 共計五人(包含上述個案),故疑爲群聚感染事件。此5名病人均罹患重症,多數合併呼吸衰竭,並放置氣管內管及使用呼吸器,以脈衝電泳法(pulsed-field gel electrophoresis; PFGE) 分析4株MDR-A. baumannii 菌株之基因型,其中2株爲同一基因型。爲確認感染源,同時採驗急診第五觀察室工作人員、留觀病人及環境檢體共104件,並未發現MDR-A. baumannii,但有13件培養出A. baumannii (留觀病人5件,環境8件),以PFGE基因分型,2株留觀病人菌株及3株環境菌株(呼吸器、床簾、心電圖監視器)爲同一基因型。本次調查結果顯示,急診第五觀察室會有2名病人移生同一株MDR-A. baumannii,另外,也意外發現一株非多重抗藥性A. baumannii已在此區之病人與環境間散佈,在嚴格採取環境淨空消毒、病人集中隔離監控、工作人員實洗手及接觸隔離等措施後,於2005年3月中旬將此次事件控制並撲滅。

並列摘要


An isolate of multidrug-resistant (MDR) Acinetobacter baumannii was found from a patient after being admitted to the 5th observation room (5th OR) at Emergency Department of a medical centre, a ward that accommodate patients awaiting admission. To clarify whether a clonal MDR-A. baumannii spreading at the 5th OR, an epidemiological study was conducted by sampling 104 specimens, included 48 environmental swabs, 29 throat-swabs of personnel and 27 sputum/throat-swabs of patients staying at the 5th OR, for bacterial culture. Medical records of patients who had stayed at the 5th OR shortly before (January-February 2005) and had MDR-A. baumiannii isolated from clinical specimens were reviewed. Thirteen specimens (8 sampled from environment and 5 from patients who were staying at the 5th OR) sampled during epidemiological study in March 2005 grew non-MDR A. baumannii isolates. Another five patients who carried MDR-A. baumannii carriage were all critically ill and endotracheal intubation for mechanical ventilation. Four MDR-A. baumannii isolates each from one of these 5 patients were sent to genotypic analysis. Fingerprinting using pussed field gel electrophoresis disclosed that 2 of the 4 MDR-A. baumannii isolates were of the same clone, while 5 non-MDR A. baumannii isolates each found in 2 patients staying at the 5th OR, and surfaces of a ventilator, a bed-side curtain and an electrocardiogram monitor were of another identical clone. The epidemiological study revealed 2 cases of MDR-A. baumannii infection/colonization, and incidentally found that one clonal non-MDR- A. baumannii soreading among patients and in the environment at ED. After implementing infection control measures, included closure of the 5th OR, environmental disinfection, patients cohorting, strict hand-washing practice and contact precautions, this cluster of A. baumannii infection/colonization was eventually controlled by mid-March 2005.

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