Successful infection control for a vancomycin-intermediate Staphylococcus aureus outbreak in an advanced emergency medical service centre
Successful infection control for a vancomycin-intermediate Staphylococcus aureus outbreak in an advanced emergency medical service centre
复制标题
DOI：
10.1016/j.jhin.2015.12.016
复制
发表时间：
2016-04-01
影响因子：
6.9
通讯作者：
Watanabe, H.
中科院分区：
文献类型：
--
作者：
Sakai, Y.;Qin, L.;Watanabe, H.
背景：2013-2014年间，某高级急救医疗服务中心(以下简称重症监护室)发生了一起万古霉素中间层金黄色葡萄球菌(VISA)暴发疫情，其最低抑菌浓度为4 mg/L。目的：对成功的感染控制措施进行评价。14株Visa菌株被确认为移居。然而，从三名肺炎住院患者的痰中分离出三种VISA菌株。进行了环境培养，并在65个地点中的5个地点检测到VISA菌株。对21株VISA分离株进行脉冲场凝胶电泳法(PFGE)和多位点序列分型(MLST)。结果：19株VISA的脉冲场凝胶电泳型和多位点序列分型结果一致，另外两株VISA可能有亲缘关系。这意味着在ICU中发生了签证毒株的水平传播。2013年8月，感染控制团队开始干预。然而，新的签证紧张住院患者继续出现。因此，2013年10月，ICU部分关闭，以试图防止进一步的水平传播，并隔离了现有的VISA毒株住院患者。虽然新病例在部分关闭后迅速消散，但花了大约5个月的时间才根除了签证暴发。结论：我们的数据表明，尽管采取了各种其他感染控制措施，但部分关闭ICU是终止此次签证暴发的关键。(C)2016年医疗感染学会。爱思唯尔有限公司出版。保留所有权利。
Background: A vancomycin-intermediate Staphylococcus aureus (VISA) (vancomycin minimum-inhibitory concentration: 4 mg/L) outbreak occurred in an advanced emergencymedical service centre [hereafter referred to as the intensive care unit (ICU)] between 2013 and 2014.Aim: Our objective was to evaluate the infection control measures that were successful.Methods: Seventeen VISA strains were isolated from the sputum of 15 inpatients and the skin of two inpatients. Fourteen VISA strains were recognized as colonization. However, three VISA strains were isolated from the sputum of three inpatients with pneumonia. Environmental cultures were performed and VISA strains were detected in five of 65 sites. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) was performed on 21 VISA strains.Findings: Molecular typing including PFGE and MLST showed that the patterns of 19 VISA strains were identical and those of the other two VISA strains were possibly related. This meant that a horizontal transmission of VISA strains had occurred in the ICU. In August 2013, the infection control team began interventions. However, new inpatients with VISA strains continued to appear. Therefore, in October 2013, the ICU was partially closed in order to try to prevent further horizontal transmission, and existing inpatients with the VISA strain were isolated. Although new cases quickly dissipated after the partial closure, it took approximately five months to eradicate the VISA outbreak.Conclusion: Our data suggest that despite the employment of various other infection control measures, partial closure of the ICU was essential in terminating this VISA outbreak. (C) 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.