International Journal of Clinical Research
International Journal of Clinical Research. 2025; 9: (9) ; 10.12208/j.ijcr.20250415 .
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江苏省徐州市贾汪区人民医院感染管理科 江苏徐州
*通讯作者： 吴晓琴,单位：江苏省徐州市贾汪区人民医院感染管理科 江苏徐州；
目的 探讨宏基因组测序（mNGS）技术在ICU耐碳青霉烯类肺炎克雷伯菌（CRKP）医院感染暴发调查中的应用。方法 2024年4月3～26日，某院 ICU 在 23天内检出6例CRKP菌株，应用传统病原学培养及mNGS基因测序对检出的CRKP菌株进行病原学鉴定以明确感染源，同时对床单元及可能污染的环境进行环境卫生学采样和进行病原微生物培养和鉴定，并采取床边隔离、手卫生等综合预防控制措施评价其效果。结果 mNGS检测结果发现6例患者标本均携带β-内酰胺酶类耐药基因CTX，经专家判定4例为医院感染、1例为社区感染、1例为定植；环境卫生学监测结果显示，在患者床栏、枕头等96个点位中检出4例CRKP，阳性率4.16%。采取单间隔离、强化手卫生等措施后，手卫生依从率从43.67%提升82.6%，患者预后良好。结论 mNGS测序技术具有精准度高、耗时短，可有效用于CRKP感染暴发溯源，持续采取手卫生、床边隔离，环境物体表面的清洁、消毒是防控CRKP感染的重要措施。
Objective To explore the application of metagenomic next-generation sequencing(mNGS) technology in the investigation of hospital infection aggregation caused by Carbapenem-resistant klebsiella pneumoniae (CRKP). Methods Using mNGS and traditional pathogen cultivation methods, pathogen detection and tracing were conducted on 6 patients withCRKP infection in a comprehensive ICU of a hospital from April 3-26, 2024. Environmental hygiene monitoring was carried out on bed units and potentially contaminated environments, and comprehensive control measures such as isolation, hand hygiene, and surface cleaning and disinfection of objects were taken to evaluate their prevention and control effects. Results The mNGS results reported that the β-lactam resistance gene CTX was isolatedfrom the samples of 6 patients. After comprehensive expert judgment, 4 patients were diagnosed with hospital infection, 1 patient was found to have sample contamination, and 1 patient was brought in from outside the hospital after colonization. this event is considered ahospital infection outbreak. The results of environmental hygiene monitoring showed that 4cases of CRKP were detected in the environment, with a positive rate of 4.16% (4/96),mainly concentrated on the patient bed rails, pillows, ECG monitor knobs, and the surface ofurine collection bags. After implementing multidisciplinary joint infection control measures,the compliance rate of doctors' hand hygiene increased from 43.67% (38/87) to 82.6% (76/92), and the prognosis of patients was good. No new cases were found in subsequent monitoring Conclusion mNGS has the characteristics of high precision, short time consumption, and high accuracy, which can be applied to the prevention and control of hospital infection outbreaks and the study of drug resistance genomes.
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