An outbreak of Acinetobacter baumannii:: The importance of cross-transmission
An outbreak of Acinetobacter baumannii:: The importance of cross-transmission
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DOI：
10.1086/501808
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发表时间：
2000-09-01
影响因子：
4.5
通讯作者：
Schaffner, W
中科院分区：
文献类型：
--
作者：
D'Agata, EMC;Thayer, V;Schaffner, W
目的：调查一起鲍曼不动杆菌多药耐药(MDR)院内感染暴发情况，分析交叉传播在感染率上升中的作用。配对病例对照研究以确定感染的危险因素。设置：一家三级保健医院的34张床位的外科重症监护病房。患者：18名发生MDR鲍曼不动杆菌医院感染的患者与36例住在同一外科重症监护病房(SICU)且在暴发期间未发生感染的患者进行配对。结果：在疫情爆发之前，MDR A鲍曼不动杆菌医院感染的基线发病率为每月3/100人。从1998年2月1日至3月22日，发病率上升到每月每100名患者中有16例，共感染18例。所有的分离物都有难以区分的PFGE图谱。70株环境培养为鲍曼氏耐药菌阴性。经过强化的感染控制教育，发病率降至每月4/100例。经条件Logistic回归分析，即使在调整了SICU住院时间、抗生素和侵入性设备的暴露后，患者暴露于MDR A鲍曼不动杆菌感染的人数仍显著高于对照组(优势比1.1；95%可信区间1.01~1.2；P=0.02)。结论：患者之间的交叉传播是MDR A鲍曼不动杆菌感染率上升的原因。未检测到常见的环境污染源。
OBJECTIVE: To investigate an outbreak of nosocomial infections due to multidrug-resistant (MDR) Acinetobacter baumannii and to analyze the contribution of cross-transmission in the rise in infection rates.DESIGN: Epidemiological investigation; molecular typing using pulsed-field gel electrophoresis (PFGE); matched case-control study to identify risk factors for infection.SETTING: A 34-bed surgical intensive care unit at a tertiary-care hospital.PATIENTS: Eighteen patients who developed MDR A baumannii nosocomial infection were matched to 36 patients who were admitted to the same surgical intensive care unit (SICU) room and did not develop an infection during the outbreak period.RESULTS: Prior to the outbreak, the baseline attack rate of MDR A baumannii nosocomial infections was 3 per 100 patients per month. From February 1 through March 22, 1998, the attack rate rose to 16 per 100 patients per month, with a total of 18 infections. All isolates had indistinguishable PFGE patterns. Seventy environmental cultures were negative for MDR A baumannii. Following intense infection control education, the attack rate decreased to 4 per 100 patients per month. By conditional logistic regression, cases were exposed to a significantly higher number of patients with MDR A baumannii infections compared to controls (odds ratio, 1.1; 95% confidence interval, 1.01-1.2; P=.02), even after adjusting for length of SICU admission and exposure to antibiotics and invasive devices.CONCLUSION: Cross-transmission between patients contributed to the rise in rates of MDR A baumannii infections. A common environmental source was not detected.