CAJ | 학술논문

目的：调查急诊住院病房多重耐药鲍曼不动杆菌（MDRABA）医院内感染暴发流行的原因，探讨控制对策的有效性。方法对急诊住院病房2013年3月2～28日发生的13例下呼吸道MDRABA感染患者进行流行病学、危险因素、环境微生物监测调查。结果患者多为老年、基础病情危重，有气管插管或气管切开联合机械通气、使用多种广谱抗菌药物、应用肾上腺糖皮质激素，低蛋白血症等多种危险因素。环境微生物监测中物体表面和手共分离到鲍曼不动杆菌17株，与患者痰液分离的13株鲍曼不动杆菌耐药谱完全相同，为MDRABA，存在对亚胺培南等碳青酶烯类抗菌药物耐药的菌株。13例患者死亡4例，治愈9例。结论医务人员诊疗操作中洗手缺乏依从性和规范性，医疗设备特别是呼吸机清洁消毒不彻底是此次患者下呼吸道MDRABA医院内感染暴发流行的主要原因。严格隔离患者、提高医务人员手卫生的依从性、对医疗设备彻底清洁消毒可预防医院内感染暴发流行。
목적：조사급진주원병방다중내약포만불동간균（MDRABA）의원내감염폭발류행적원인，탐토공제대책적유효성。방법대급진주원병방2013년3월2～28일발생적13례하호흡도MDRABA감염환자진행류행병학、위험인소、배경미생물감측조사。결과환자다위노년、기출병정위중，유기관삽관혹기관절개연합궤계통기、사용다충엄보항균약물、응용신상선당피질격소，저단백혈증등다충위험인소。배경미생물감측중물체표면화수공분리도포만불동간균17주，여환자담액분리적13주포만불동간균내약보완전상동，위MDRABA，존재대아알배남등탄청매희류항균약물내약적균주。13례환자사망4례，치유9례。결론의무인원진료조작중세수결핍의종성화규범성，의료설비특별시호흡궤청길소독불철저시차차환자하호흡도MDRABA의원내감염폭발류행적주요원인。엄격격리환자、제고의무인원수위생적의종성、대의료설비철저청길소독가예방의원내감염폭발류행。
Objective To investigate the causes of multi-drug resistant acinetobacter baumannii(MDRABA) nosocomial infection outbreak in the wards of emergency department ,and to explore effective control measures. Methods A total of 13 pa-tients with lower respiratory tract infection of MDRABA ,who were in the wards of Emergency Department from March 2nd to 28th 2013,were investigated on epidemiology,risk factors and environmental microbiological monitoring. Resutls Most of the patients had multiple risk factors such as the elderly,serious basic diseases,tracheal intubation or tracheotomy+mechanical ventilation,the use of a variety of broad-spectrum antibiotics,application of adrenocortical hormone,hypoproteinemia and so on. 17 strains of acinetobacter baumannii were isolated from surface and hands of objects in environmental microbiological monitoring ,drug resis-tant spectrum of which were exactly the same as that of 13 strains of acinetobacter baumannii isolated from sputum of patients. These strains of acinetobacter baumannii were confirmed as MDRABA ,including antimicrobial drug resistance to carbapenems as imipenem. Among 13 patients,4 cases died,and the other 9 cases were cured. Conclusion Medical personnel is lack of the compliance and normative of washing hands ,medical equipments especially as ventilators are with incomplete cleaning and disin-fection. Both above were the main causes of the outbreak of lower respiratory tract hospital infection in MDRABA. Strict isolation of patients,improvement of hand-washing compliance and complete cleaning and disinfection of medical equipments can prevent outbreak of hospital infection.