Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center.
Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center.
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高级急救医疗服务中心耐碳青霉烯类肠杆菌科爆发的感染控制。
DOI：
10.3390/antibiotics10121537
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发表时间：
2021-12-15
期刊：
影响因子：
--
通讯作者：
Watanabe H
中科院分区：
文献类型：
--
作者：
Sakai Y;Gotoh K;Nakano R;Iwahashi J;Miura M;Horita R;Miyamoto N;Yano H;Kannae M;Takasu O;Watanabe H
背景资料：2016年至2017年，一家高级急救医疗服务中心[以下简称重症监护室（ICU）]发生了碳青霉烯类耐药肠杆菌科（CRE）疫情。目的：我们的目的是评估CRE暴发的感染控制措施。方法：对16例多中心住院患者进行CRE菌株检测。进行了环境培养，在38个检测点中的3个检测到CRE菌株。对25株CRE进行脉冲场凝胶电泳（PFGE）、多位点序列分型（MLST）和β-内酰胺酶基因检测。调查结果：分子分型结果显示，4株肺炎克雷伯菌中有2株PFGE图谱为亲缘关系近且MLST相同（ST 2388），5株阴沟肠杆菌中有4株PFGE图谱为亲缘关系近且MLST相同（ST 252）。25株CRE菌株中有23株含有IMP-1 β-内酰胺酶基因，23株CRE菌株中有15株含有IncFIIA复制子区域。尽管感染控制小组进行了干预，但新的CRE菌株住院患者继续出现。因此，ICU部分封闭，对住院CRE患者进行隔离，ICU工作人员将CRE菌株住院患者和非CRE菌株住院患者分为两组，避免交叉污染。虽然新病例的发生在部分关闭后迅速消失，但需要几个月的时间才能消除CRE的爆发。结论：我们的数据表明，用于感染控制的各种综合措施对阻止CRE爆发至关重要。特别是，部分关闭隔离ICU和ICU工作人员的分工是有效的。
Background: A carbapenem-resistant Enterobacteriaceae (CRE) outbreak occurred in an advanced emergency medical service center [hereafter referred to as the intensive care unit (ICU)] between 2016 and 2017. Aim: Our objective was to evaluate the infection control measures for CRE outbreaks. Methods: CRE strains were detected in 16 inpatients located at multiple sites. Environmental cultures were performed and CRE strains were detected in 3 of 38 sites tested. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and detection of β-lactamase genes were performed against 25 CRE strains. Findings: Molecular typing showed the PFGE patterns of two of four Klebsiella pneumoniae strains were closely related and the same MLST (ST2388), and four of five Enterobacter cloacae strains were closely related and same MLST (ST252). Twenty-three of 25 CRE strains harbored the IMP-1 β-lactamase gene and 15 of 23 CRE strains possessed IncFIIA replicon regions. Despite interventions by the infection control team, new inpatients with the CRE strain continued to appear. Therefore, the ICU was partially closed and the inpatients with CRE were isolated, and the ICU staff was divided into two groups between inpatients with CRE and non-CRE strains to avoid cross-contamination. Although the occurrence of new cases dissipated quickly after the partial closure, a few months were required to eradicate the CRE outbreak. Conclusion: Our data suggest that the various and combined measures that were used for infection control were essential in stopping this CRE outbreak. In particular, partial closure to isolate the ICU and division of the ICU staff were effective.
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影响因子：
2.8
作者：
Ribot, Efrain M.;Fair, M. A.;Barrett, Timothy J.
通讯作者：
Barrett, Timothy J.
影响因子：
9.4
作者：
TENOVER, FC;ARBEIT, RD;SWAMINATHAN, B
通讯作者：
SWAMINATHAN, B
影响因子：
5.5
作者：
Hopman, Joost;Tostmann, Alma;vd Hoeven, Hans
通讯作者：
vd Hoeven, Hans
影响因子：
4.9
作者：
Shields, Ryan K.;Nguyen, M. Hong;Clancy, Cornelius J.
通讯作者：
Clancy, Cornelius J.
影响因子：
5.2
作者：
Dallenne, Caroline;Da Costa, Anaelle;Arlet, Guillaume
通讯作者：
Arlet, Guillaume