综合医院病房检出产碳青霉烯酶铜绿假单胞菌后接触患者暴发及医院环境调查

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-02-21 DOI:10.1016/j.jhin.2025.02.009

A.C. Büchler, C.H.W. Klaassen, I. de Goeij, M.C. Vos, A.F. Voor in ’t holt, J.A. Severin

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引用次数: 0

摘要

背景：已知产碳青霉烯酶铜绿假单胞菌（CPPA）可在卫生保健机构引起疫情。疫情调查，包括筛查接触者和环境，是感染预防和控制（IPC）管理以遏制疫情的关键。目的：本研究的目的是确定在普通病房住院患者的临床或筛选培养中意外检测到CPPA后进行的爆发调查的产量。方法：在这项回顾性队列研究中，我们纳入了2011年6月至2021年12月在普通病房住院的所有新发现CPPA的成年患者（“指数患者”）。我们评估了开展的疫情调查，即筛查流行病学相关患者（“接触患者”）和环境。分离株采用全基因组测序（WGS）进行分析。结果：38例指数患者中34例（89.5%）进行了暴发调查，其中34例（100%）进行了接触者筛查，18例（52.9%）进行了环境筛查。8例（44.4%）环境筛查检测到CPPA， 4例（22.2%）WGS与该指标相关。共筛查1982例接触者1707例（86.1%），其中8例携带CPPA（0.5%）。WGS确认其中5例（0.3%）由指示患者传播给接触患者。结论：环境筛查应成为防治艾滋病疫情调查的一部分，因为它可以确定来源，从而能够及时采取有针对性的防治措施。在我们的研究中，很少发现患者从指数到接触者的传播，这意味着需要重新考虑高危接触者的定义。

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Outbreak investigations of contact patients and the hospital environment after detection of carbapenemase-producing Pseudomonas aeruginosa on general hospital wards

Background

Carbapenemase-producing Pseudomonas aeruginosa (CPPA) is known to cause outbreaks in healthcare settings. Outbreak investigations, including screening of contact patients and the environment, are key in infection prevention and control (IPC) management to contain them.

Aim

The aim of this study was to determine the yield of outbreak investigations performed after unexpected detections of CPPA in clinical or screening cultures of patients hospitalized on a general ward.

Methods

In this retrospective cohort study, we included all adult patients newly detected with CPPA (‘index patients’) while hospitalized on a general ward from June 2011 to December 2021. We evaluated the outbreak investigations performed, i.e., screening of epidemiologically linked patients (‘contact patients’) and the environment. Isolates were analysed by whole-genome sequencing (WGS).

Findings

Outbreak investigations of 34 of 38 (89.5%) index patients were evaluated, with screening of contact patients performed in 34 (100%) and the environment in 18 (52.9%). CPPA was detected in eight (44.4%) of the environmental screenings, and WGS confirmed relatedness to the index in four (22.2%). A total of 1707 of 1982 (86.1%) identified contact patients were screened, of which eight carried CPPA (0.5%). WGS confirmed transmission from index patient to contact patient in five of these (0.3%).

Conclusion

Environmental screening should be part of outbreak investigations for CPPA, as it identifies sources which enables timely installation of targeted IPC measures. Identification of index-to-contact patient transmission was rare in our setting, thus implying reconsideration of the definition of contact patients at high risk is needed.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.