在一个低发病率环境中,成功控制了一个与医院内传播有关的产NDM肺炎克雷伯氏菌环境库。

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Estelle Moulin, Paraskevas Filippidis, Corinne Aymon Paire-Ficout, Dominique S Blanc, Bruno Grandbastien, Laurence Senn
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引用次数: 0

摘要

背景:据报道,在各种环境中,医院废水系统是产碳青霉烯酶肠杆菌科细菌 (CPE) 的院内感染源。清洁和消毒方案或更换受污染的设备往往无法根除这些环境蓄水池,从而导致 CPE 的长期传播。我们报告了一种成功控制新德里金属-β-内酰胺酶阳性肺炎克雷伯菌(NDM-KP)院内爆发的多模式方法,该方法牵涉到低发病率环境中的水槽收集器污染:在一名住院病人的尿液培养中偶然发现 NDM-KP 后,我们进行了流行病学调查,包括病人和环境 CPE 筛查以及菌株的全基因组测序 (WGS)。我们还实施了多模式感染预防和控制(IPC)措施,即隔离病例、无水病人护理、更换受污染的 P 型捕捉器和连接件、对水槽进行为期 6 个月的漂白剂和蒸汽消毒,然后对病人和环境进行筛查,以根除感染:结果:2022 年 2 月至 5 月间,一个拥有 8 张病床的神经外科中级护理病房发现了 5 例 NDM-KP 病例。在该病房的 8 个水槽中,有 3 个对 NDM-KP 呈阳性反应。患者和环境分离物属于多焦点序列分型 ST-268。所有分离株的基因组在遗传学上非常相似,表明存在交叉传播,环境可能是传播源。在采取综合 IPC 措施后,没有发现新的病例,而且在干预措施后的 6 个月内,水槽捕集器对 NDM-KP 的检测仍为阴性:结论:实施多模式 IPC 措施,包括无水病人护理、更换和消毒 P 型水槽和连接件,在 8 个月后成功控制了 NDM-KP。在发病率较低的环境中,这种方法实现了产碳青霉烯酶肠杆菌科细菌(CPE)零传播的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Successful control of an environmental reservoir of NDM-producing Klebsiella pneumoniae associated with nosocomial transmissions in a low-incidence setting.

Background: The hospital wastewater system has been reported as a source of nosocomial acquisition of carbapenemase producing Enterobacteriaceae (CPE) in various settings. Cleaning and disinfection protocols or replacement of contaminated equipment often fail to eradicate these environmental reservoirs, which can lead to long-term transmission of CPE. We report a successful multimodal approach to control a New Delhi metallo-beta-lactamase positive Klebsiella pneumoniae (NDM-KP) nosocomial outbreak implicating contamination of sink traps in a low-incidence setting.

Methods: Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated P-traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication.

Results: Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Following the introduction of combined IPC measures, no new case was subsequently detected and sink traps remained negative for NDM-KP within 6 months after the intervention.

Conclusion: The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of P-traps and connecting pieces, was successful in the control of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE).

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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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