复杂的感染控制措施与消毒剂转换有助于成功地早期控制重症监护病房中耐碳青霉烯类鲍曼不动杆菌的爆发

Jozsef Kelemen, Marton Sztermen, Eva Krisztina Dakos, Jozsef Budai, Jozsef Katona, Zsuzsanna Szekeressy, Laszlo Sipos, Zoltan Papp, Balazs Stercz, Zsuzsanna A. Dunai, Bela Kocsis, Janos Juhasz, Fruzsina Michelisz, Zsuzsanna Daku, Judit Domokos, Dora Szabo, Lorand Eross
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引用次数: 0

摘要

重症监护病房(ICU)中爆发的耐碳青霉烯类鲍曼不动杆菌(CRAB)疫情是通过改进感染控制措施(包括消毒剂政策)而得到控制的。在这项回顾性队列研究中,我们描述了疫情爆发期间的流行病学调查和感染控制措施。通过描述性分析总结了患者的人口统计学特征、神经系统疾病、手术治疗、基础疾病、感染和结果。2023 年 12 月,重症监护室观察到两名 CARB 阳性患者,1 月份又有四名患者出现 CRAB 阳性。在此次疫情中,CRAB 阳性患者的住院时间有重叠,从环境中分离出了 CRAB;分离出的 CRAB 株系完全相同。对感染控制措施进行了审查和修改,包括手部卫生、接触预防和隔离、监测、去菌、环境清洁和消毒。本研究的目的是研究在成功控制疫情期间所使用的消毒剂转变的有效性的分子背景。实验研究了不同消毒剂的表型敏感性和遗传背景。对检测到的 CRAB 菌株进行的全面分析包括全基因组测序(WGS)、通过 qPCR 调查暴露于不同消毒剂溶液后 qacE 和 qacEΔ1 基因的相对表达以及生物膜形成分析。对 CRAB 菌株进行的 WGS 分析表明,ST2 高风险克隆是造成疫情爆发的原因,它能产生 OXA-83 和 ADC-30 β-内酰胺酶;此外,还检测到了 qacE 和 qacEΔ1 基因,它们能赋予细菌对含有季铵化合物 (QAC) 的消毒剂的抗性。qPCR 分析表明,在接触不同的消毒剂后,qacE 和 qacEΔ1 的基因表达水平升高,并与消毒剂的 QACs 浓度相关。在疫情爆发期间,重症监护室将标准护理用的 QAC 型消毒剂改为主要以酒精为基础的消毒剂,从而成功控制了疫情,并且没有发现其他 CRAB 患者。我们得出的结论是,持续监控和手部卫生培训与快速识别和应对新病例相结合,以及在疫情爆发期间深入分析耐多药爆发菌株并调查其对消毒剂的耐受性/抗药性,对于有效控制医院病原体的传播至关重要。明智的消毒剂选择政策在控制疫情和确保重症监护室病人安全方面发挥了至关重要的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Complex Infection-Control Measures with Disinfectant Switch Help the Successful Early Control of Carbapenem-Resistant Acinetobacter baumannii Outbreak in Intensive Care Unit
A carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an intensive care unit (ICU) was contained by an improved infection-control measure that included a disinfectant policy. In our retrospective cohort study, we describe the epidemiological investigations and infection-control measures during this outbreak. Descriptive analysis was used to summarize patient demographics, neurological diseases, surgical treatment, underlying diseases, infection, and outcomes. In December 2023, two CARB-positive patients were observed in the ICU, and four more patients became CRAB-positive in January. During this outbreak, there was an overlap of hospitalization periods among the CRAB-positive patients, and CRAB was isolated from the environment; the isolated CRAB strain was identical. Infection-control measures, including hand hygiene, contact precautions and isolation, surveillance, decolonization, environmental cleaning, and disinfection, were reviewed and modified. The aim of this study was to examine the molecular background of the effectiveness of the disinfectant shift used during successful outbreak control. Experiments were carried out to study the phenotypic sensitivity and genetic background of different disinfectant agents. A thorough analysis of the detected CRAB strain included whole-genome sequencing (WGS), investigation of the qacE and qacEΔ1 genes’ relative expression by qPCR after exposure to different disinfectant solutions, as well as an analysis of biofilm formation. WGS analysis of the CRAB strain identified that an ST2 high-risk clone was responsible for the outbreak, which produced OXA-83 and ADC-30 beta-lactamases; in addition, qacE and qacEΔ1 genes were also detected, which confer resistance to disinfectants containing quaternary ammonium compounds (QACs). A qPCR analysis demonstrated that after exposure to different disinfectants, the gene expression levels of qacE and qacEΔ1 increased and correlated with concentrations of QACs of disinfectants. During the outbreak, the standard-of-care QAC-based disinfectant was changed to a mainly alcohol-based agent in the ICU, which contributed to the successful control of this outbreak, and no additional patients were identified with CRAB. We conclude that continuous surveillance and hand hygiene training combined with fast identification and reaction to new cases, as well as an in-depth analysis of multidrug-resistant outbreak strains and investigation of their disinfectant tolerance/resistance during an outbreak, are essential to effectively control the spread of nosocomial pathogens. The smart policy of disinfectant agent selection played a crucial role in controlling the outbreak and ensuring patient safety in the ICU.
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