Investigation of an outbreak of carbapenem resistant Acinetobacter baumannii in an intensive care unit during the COVID-19 epidemic.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Yi Kong, Ting Liu, Yanru Zhang, Hui Wang, Hongyi Lin
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Abstract

Background: During the Coronavirus Disease 2019 (COVID-19) epidemic, the strain on intensive care units (ICUs) has increased, which made them more vulnerable to the threat of multidrug-resistant organism (MDRO).

Aim: This study aims to investigate an outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) infection in a general adult ICU of a tertiary hospital in China during the COVID-19 epidemic and evaluate the effectiveness of intervention measures.

Methods: Demographic and clinical data of 37 patients were collected, and 230 environmental samples were collected. Whole genome sequencing (WGS) analysis was performed on clinical and environmental isolates. An evolutionary tree was constructed based on the WGS data. The infection control team implemented a bundle of MDRO interventions, including a termination of COVID-19 infection control measures and implementation of 'three-step' cleaning and disinfection method.

Findings: There were 37 patients found to have CRAB infection or colonization in the ICU from December 2022 to April 2023, of whom 35 were hospital-acquired. 12 CRAB isolates were obtained from the environment and medical equipment. Through WGS analysis, the CRAB strains from the medical environment and bronchoscopes were found to be highly homologous to those from patients' clinical specimens. This demonstrated that the infection outbreak was caused by the lack of MDRO prevention and control measures. Following intervention, the CRAB detection rate gradually declined, with no positive samples for CRAB found in the ICU environment or on bronchoscopes.

Conclusion: The infection control measures for COVID-19 conflicted with basic MDRO prevention and control strategies, likely contributing to the outbreak. Therefore, established infection prevention and control measures should be consistently followed, as they represent the most effective approach to preventing MDRO.

2019冠状病毒病疫情期间重症监护病房发生耐碳青霉烯类鲍曼不动杆菌疫情的调查
背景:在2019冠状病毒病(COVID-19)流行期间,重症监护病房(icu)的压力增加,使其更容易受到多药耐药菌(MDRO)的威胁。目的:调查2019冠状病毒病疫情期间中国某三级医院普通成人ICU暴发的耐碳青霉烯类鲍曼不动杆菌(CRAB)感染情况,并评价干预措施的效果。方法:收集37例患者的人口学及临床资料,收集环境样本230份。对临床和环境分离株进行全基因组测序(WGS)分析。基于WGS数据构建了进化树。感染控制小组实施了一系列MDRO干预措施,包括终止COVID-19感染控制措施和实施“三步”清洁和消毒方法。结果:2022年12月至2023年4月,ICU共发现螃蟹感染或定植37例,其中医院获得性35例。从环境和医疗设备中分离出12株螃蟹。通过WGS分析,从医学环境和支气管镜中发现的螃蟹菌株与患者临床标本高度同源。这表明,感染的爆发是由于缺乏预防和控制措施。干预后,螃蟹检出率逐渐下降,ICU环境及支气管镜检查均未发现螃蟹阳性标本。结论:新型冠状病毒感染控制措施与MDRO基本防控策略存在冲突,可能是疫情爆发的原因之一。因此,应始终遵循既定的感染预防和控制措施,因为它们是预防MDRO的最有效方法。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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