新生兒Methicilline抗藥性金黃色葡萄球菌院內群突發之流行病學調查與處理

Nosocomial Outbreak of Methicillin-resistant Staphylococcus Aureus Skin Infection in Neonates: Epidemiology and Management

吳文豪(Wen-Hao Wu) ； 邱婷芳(Ting-Fang Chin) ； 李坤美(Kun-Mei Lee) ； 吳幸霖(Hsin-Lin Wu) ； 杜戎玨(Jung-Chieh Du) ； 王登鶴(Teng-Ho Wang) ； 翁夢璐(Meng-Lu Weng) ； 陳敏芳(Min-Fong Chen)

《北市醫學雜誌》 4卷1期 (2007/01) Pp. 47-55

https://doi.org/10.6200/TCMJ.2007.4.1.06

摘要

目的：methicilline抗藥性金黃色葡萄球菌(MRSA)已成為院內感染的主要感染原。本研究乃探討某區域醫院嬰兒室新生兒感染MRSA之群突發事件，採取流行病學調查，和感染控制措施。方法：於95年6月30日至7月30日以普查方式，由醫師理學檢查嬰兒室新生兒是否罹患膿疱疹，亦普查醫護人員是否罹患皮膚病，手和鼻腔採樣送檢，送檢樣本皆以傳統微生物學檢測，同時進行抗生素敏感試驗，復以RAPD和PFGE分析做分子分型檢測。結果：經普查共發現三位新生兒罹患膿疱疹，發病時間相近，經抗生素治療後痊癒，其中二位培養出MRSA，而29位醫護人員有三位在鼻腔樣本培養出MRSA，陽性率為10%，所有五個菌株皆接受RAPD和PFGE分析所呈現之片段大致相同，菌株之基因分型證實為醫護人員新生兒傳播途徑。所有MRSA帶原者立刻不再照顧新生兒，並加強院內感控措施，截至八月底，並沒有新個案發生。結論：（一）於嬰兒室持續進行標準感控措施和手部衛生是必要的。（二）以普查方式找出醫護人員中MRSA帶原者對院內感染MRSA是很重要的。（三）PFGE基因分型可確認病原感染途徑。

關鍵字

methicilline抗藥性金黃色葡萄球菌 ； 膿疱疹 ； 院內群突發 ； 脈動式電泳

並列摘要

Background and Purpose: Methicilline-resistant staphylococcus aureus (MRSA) has become an important nosocomial pathogen. The objective of this study was to investigate and control MRSA outbreak in the nursery of a community hospital. Method: During one month (June 30, 2006~July 30, 2006), we conduct a surveillance for pustulosis of newborns in nursery and dermatological illness of health-care workers. Skin and nasal cultures were obtained from health-care workers who have contact with patients. The specimens received microbiological examination and antibiotics sensitivity, were further typed by molecular methods. Results: Three newborns were identified as pustulosis with related time sequence. They were cured by antibiotics treatment. Two of them are proved with culture confirmed MRSA. MRSA where also isolated from three nasal swabs of 29 health-care workers, with 10% prevalence rate. All five isolates were identified by RAPD and PFGE analysis which depicted similar bands patterns. The genotyping of the strains confirmed the health-care worker to newborns transmission. All MRSA carriers were forbidden to take care of newborn and strict nosocomial infection control procedures were emphasized. No additional case occur until the end of August. Conclusion: (1) adhering to standard infection control practice and hand hygiene is essential in newborn nursery. (2) Identification of MRSA carriers among health-care worker using surveillance is important for controlling nosocomial MRSA infection. (3) The genotyping by PFGE can confirm the transmission route of pathogens.

並列關鍵字

methicilline-resistant staphylococcus aureus ； pustulosis ； nosocomial outbreak ； pulse-field gel electrophoresis