南台灣某教學醫院外科加護病房萬古黴素抗藥性屎腸球菌群突發調查

A Vancomycin-resistant Enterococcus faecium (VREfm) Outbreak Surveillance Report in the Surgical Intensive Care Unit of a Teaching Hospital in Southern Taiwan

萬古黴素抗藥性屎腸球菌（Vancomycin-resistant Enterococcus faecium, VREfm）為醫療照護相關感染重要的抗藥性菌種之一。南部某教學醫院於2020年8月常規監測發現某外科加護病房的VREfm菌株較2020上半年增加，經主管會診感染管制中心介入調查後，確認該單位發生VREfm群突發事件，於2020年8月至10月執行多項感染管制措施：全病房病人VREfm主動篩檢、啟動分子流行病學調查、加強VREfm感染或移生的病人VRE接觸防護措施、病室環境及儀器採檢並進行VREfm培養、督促環境清潔消毒、監測環境清潔效度，及提供人員教育訓練。於2020年8月至9月，共有7位病人臨床檢體檢驗出VREfm，4位符合醫療照護相關感染，3位為移生案例。針對所分離出之VREfm菌株進行藥敏測試，3位個案的VREfm菌株藥物敏感性相同，再進行多位點序列分型分析，結果顯示此3位個案VREfm具分生相關性。環境採檢並無培養陽性，但使用生物冷光儀Adenosine triphosphate進行環境清潔效度監測，結果顯示清潔效度不佳，加強單位員工清潔在職教育後再次稽核與檢測，結果均無不合格。經介入後，該單位於同年11月後無新VREfm培養陽性個案，其VREfm醫療照護相關感染感染密度亦無持續上升。

Vancomycin-resistant Enterococcus faecium (VREfm) is a major pathogen that causes healthcare-associated infections. A routine hospital-wide monitoring system in the surgical intensive care unit of a teaching hospital showed an increased number of VREfm isolates in August 2020 versus that in the first half of 2020. A VREfm outbreak was confirmed after the head nurse consulted the infection control department. Several infection control strategies were implemented between August and October 2020. Active VREfm surveillance of all patients, a relevant molecular epidemiological survey, reinforcement of contact precautions for all patients diagnosed or colonized with VREfm, ward surrounding and equipment sampling for VREfm culture, supervised environmental cleaning and disinfection processes, adenosine triphosphate (ATP) luminometer-based environmental cleaning process assessment, and provision of infection control education for members of staff were performed. Between August and September 2020, seven VREfm clinical isolates were cultured from seven patients: four with health care-associated infection and three with VREfm colonization. Three VREfm isolates had the same drug susceptibility and sequence typing type, indicating an epidemiological relationship among them. The ward surroundings and equipment samples tested negative for VREfm growth. However, an inadequate cleaning process was identified via an ATP-based assessment. After immediate feedback and infection control education were provided to the staff, no further abnormalities were observed in the ATP-based assessment. Since the intervention (November 2020), no new VREfm isolates have been detected among patients admitted to the surgical intensive care and the prevalence of healthcare-associated VRE infections returned to baseline over the following months.