非重症监护病房患者耳念珠菌定植的分离鉴定及防控策略
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Isolation, identification, and prevention-control strategies for Candida auris colonization in non-ICU patients
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    摘要:

    目的 调查某院非重症监护病房患者耳念珠菌定植及环境污染情况,评价该病区感染防控措施及其效果。方法 2024年3月某院康复医学科病房收治1例双下肢截瘫患者,导尿管和尿培养均检出耳念珠菌,立即对该患者单间隔离,暂停所在病区患者转入及转出,并对病房环境及进出病房的陪护家属、医生、护士和该病区同一时间住院的患者采样进行真菌培养,使用质谱和分子生物学技术进行菌种鉴定和聚类分析。对患者采取接触隔离措施,严格执行手卫生,使用含有效氯1 000 mg/L的次氯酸钠消毒,2%氯己定去定植,以及对患者接触的物品采取终末消毒等防控措施。出院后继续执行上述防控措施并定期复查患者耳念珠菌定植情况。结果 从患者尿、导尿管、腹股沟拭子、肛周拭子和床架边缘拭子分离5株耳念珠菌。蛋白质谱聚类分析显示,5株耳念珠菌为同一来源。此分离株对氟康唑和两性霉素B均耐药,对棘白菌素类抗真菌药物均敏感。病区其他人员手部、腋窝和腹股沟处皮肤拭子均未分离出耳念珠菌。经去定植及环境消毒等措施后,第2轮复查采样培养均无耳念珠菌生长。结论 非重症监护病房需根据入院患者特点,从转入初筛、接触预防、物体表面微生物学监测、消除定植、环境消毒及社区管理等多方面入手,积极采取主动防控措施。手卫生、接触隔离和终末消毒是阻断耳念珠菌传播的重要手段。

    Abstract:

    Objective To investigate Candida albicans (C. auris) colonization in patients and environmental contamination of non-intensive care unit (non-ICU) in a hospital, and evaluate the effectiveness of infection prevention and control measures in non-ICU. Methods In March 2024, a paraplegic patient admitted to the department of rehabilitation medicine was found to have C. auris in bothurinary catheter and urine culture. The patient was immedia-tely isolated in single room, and patient transfer-in/out of non-ICU was suspended. Fungal cultures were performed on specimens from the ward environment, caregivers, doctors, nurses, and co-hospitalized patients. Mass spectrometry and molecular biology techniques were used for strain identification and cluster analysis. Contact isolation was conducted on patient. Prevention and control measures were taken, including strict hand hygiene, 1 000 mg/L chlorine-based (sodium hypochlorite) disinfection, 2% chlorhexidine decolonization, and terminal disinfection of patient-contact items. After discharge, these measures continued with regular C. auris surveillance. Results Five strains of C. auris were isolated from the patient’s urine, urinary catheter, inguinal swab, perianal swab, and bed rail swab. Protein mass spectrometry cluster analysis confirmed clonal relatedness of all isolates. The strain showed resistance to fluconazole and amphotericin B, but susceptibility to echinocandins. No C. auris was detected from healthcare workers’ hand/axillary/groin swabs. After intervention (such as decolonization and environmental disinfection), follow-up cultures were negative for C. auris. Conclusion Based on the characteristics of admitted patients, non-ICU should implement active prevention and control measures including: admission screening, contact precautions, object surface microbiological monitoring, decolonization, environmental disinfection, and community management. Hand hygiene, contact isolation, and terminal disinfection are crucial for preventing C. auris transmission.

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徐丹,熊键,胡志敏.非重症监护病房患者耳念珠菌定植的分离鉴定及防控策略[J]. 中国感染控制杂志,2025,24(5):602-608. DOI:10.12138/j. issn.1671-9638.20256914.
XU Dan, XIONG Jian, HU Zhimin. Isolation, identification, and prevention-control strategies for Candida auris colonization in non-ICU patients[J]. Chin J Infect Control, 2025,24(5):602-608. DOI:10.12138/j. issn.1671-9638.20256914.

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  • 收稿日期:2024-08-27
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  • 在线发布日期: 2025-05-23
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