Eradication of multi-drug resistant Acinetobacter from an intensive care unit.
Eradication of multi-drug resistant Acinetobacter from an intensive care unit.
复制标题
根除重症监护室中的多重耐药不动杆菌。
DOI：
10.1089/10962960152813331
复制
发表时间：
2001
影响因子：
2
通讯作者：
L. Thrupp
中科院分区：
文献类型：
--
作者：
Y. Podnos;M. Cinat;S. Wilson;Jonathon Cooke;W. Gornick;L. Thrupp
背景
鲍曼不动杆菌是一种引起ICU医院感染暴发的革兰氏阴性球菌。由于对多种抗生素的耐药性，对鲍曼不动杆菌聚集性的管理在根除多重耐药感染方面是有用的模式。我们概述了鲍曼不动杆菌暴发的演变，重点介绍了传播方法和旨在将其从ICU中消除的多学科措施。
方法
这项研究包括1996年11月至1997年12月在城市三级护理医疗中心接受多重耐药鲍曼不动杆菌培养阳性的患者。鲍曼不动杆菌在血琼脂和麦康基培养上分离，经Vitek平板鉴定。纸片扩散法包括阿米卡星、亚胺培南、多粘菌素B和舒巴坦。
结果
52例患者(27例感染，25例定居)68个阳性部位的暴发始于一名定居的烧伤患者从外部医院转移到50%的总体表面积。在3天内，指标患者进入烧伤ICU、冠心病监护病房和内科ICU。很快，在这些病房以及最终的外科ICU中，发现了一群群只对多粘菌素B敏感的鲍曼不动杆菌感染患者。在分型上，发现了2株PFGE B和C，考虑到抗生素耐药水平，有定植或感染的患者被队列并进行接触隔离。制定了严格的消毒措施，如洗手、隔离屏障、清洗设备和房间、对呼吸机设备进行消毒、为每位患者配备医疗设备等。尽管如此，在呼吸机的隔水器、水槽和护栏中仍发现了阳性的环境培养物。零星病例总共持续了13个月，感染造成10人死亡。
结论
鲍曼不动杆菌是一种对抗菌剂产生抗药性的中等毒力的微生物。由于多重耐药性，严格的接触隔离、队列和杀菌技术是主要的遏制方式。这次暴发是从重症监护病房根除耐多药微生物的典范。随着医院内的微生物对抗菌剂产生越来越多的耐药性，这些措施将变得更加重要。
BACKGROUND
Acinetobacter baumannii is a gram-negative coccobacillus that causes outbreaks of nosocomial infections in ICUs. Due to resistance to multiple antibiotics, management of clusters of A. baumannii is useful as a model in eradication of multi-drug resistant infections. We outline the evolution of an A. baumannii outbreak, focusing on methods of transmission and multidisciplinary measures aimed at eliminating it from the ICU.
METHODS
Patients in an urban, tertiary care medical center from November 1996 to December 1997 having positive cultures for multi-drug resistant A. baumannii are included in this study. A. baumannii was isolated on blood agar and MacConkey cultures and identified by Vitek panel. Disk diffusion including amikacin, imipenem, polymyxin B, and sulbactam were used to determine resistance.
RESULTS
An outbreak of 52 patients (27 infected, 25 colonized) with 68 positive sites began with the transfer of a colonized >50% total body surface area burn patient from an outside hospital. Within 3 days, the index patient was in the burn ICU, coronary care unit, and medical ICU. Soon, clusters of patients with A. baumannii infections sensitive only to polymyxin B were seen in those units and, ultimately, the surgical ICU. On typing, 2 strains were found, PFGE B and C. Given the level of antibiotic resistance, patients with colonization or infection were cohorted and placed on contact isolation. Strict antiseptic measures, such as hand-washing, barrier isolation, equipment and room cleaning, sterilization of ventilator equipment, and dedication of medical equipment to each patient were instituted. Still, positive environmental cultures were found in ventilator water traps, sinks, and bedrails. Sporadic cases continued for a total of 13 months, with 10 deaths resulting from the infections.
CONCLUSION
A. baumannii is a mildly virulent organism that becomes resistant to antimicrobials. Because of multiple antibiotic resistance, strict contact isolation cohorting and antiseptic technique are the primary modes of containment. This outbreak serves as a model of eradication of multi-drug resistant organisms from ICUs. These measures will become of greater importance as nosocomial organisms develop increasing resistance to antimicrobials.