两家新生儿重症监护室发生曲霉聚集感染：5名极早产儿确诊、1人死亡，疾控中心发布调查
美国疾病控制与预防中心（CDC）11月5日在《发病率与死亡率周报》（MMWR）报告两起新生儿重症监护室（NICU）皮肤曲霉感染聚集：2023 年至 2024 年，密歇根州与纽约州各有一家四级 NICU 检出聚集病例，共 5 名极早产儿（胎龄不足 28 周）确诊皮肤曲霉病，其中密歇根州 1 名婴儿死亡，纽约州 3 名婴儿全部存活；两起调查都没有找到明确的环境来源。
密歇根州的聚集发生在 2023 年 10 月至 11 月：2 名胎龄不足 24 周的极早产儿在出生第一周先后出现皮肤病变，培养均检出烟曲霉（Aspergillus fumigatus），2 人都接受了两性霉素 B 治疗，首例婴儿在出生第二周死亡，死因归于曲霉病所致脓毒性休克、铜绿假单胞菌感染与极度早产。调查人员在布草运输走廊附近采集的一份空气样本中也检出烟曲霉。院方随后把共用育婴室的负压区改为正压，以降低空气中孢子传播风险，并修复管道渗漏与地板，为洁净布草和物资设置单独的装卸区。
纽约州的聚集发生在 2024 年 7 月至 9 月：3 名极早产儿先后确诊，胎龄分别为 24 至 25 周、24 至 25 周与不足 24 周，分离株为烟曲霉 1 株与近缘种 Aspergillus quadrilineatus 2 株；3 人分别接受米卡芬净、伏立康唑联合两性霉素 B、两性霉素 B 治疗，全部存活。该院没有做环境采样，整改措施包括加强布草干燥检查、部分改用无菌毛巾、极早产儿改用一次性体位固定装置、出生头 4 天护理时戴无菌手套，以及提前更换高效空气过滤器。截至 2026 年 9 月 1 日，两家 NICU 都没有再发现新增病例。
CDC 指出，皮肤曲霉病对极早产儿可以危及生命：这类婴儿免疫防御未成熟、皮肤屏障未发育完全，又频繁接触侵入性医疗器械。临床人员对极早产儿新出现的红斑、溃疡、坏死或其他可疑皮肤病变应考虑这一感染，及时做培养或活检与物种级鉴定，并与感染防控人员、设施工程师和公共卫生部门协同评估处置；整改不应等到找到明确来源之后才启动。
Cutaneous Aspergillosis Clusters Hit Two NICUs: Five Extremely Preterm Infants Infected, One Death, CDC Reports
The U.S. Centers for Disease Control and Prevention (CDC) reported two clusters of cutaneous aspergillosis in neonatal intensive care units (NICUs) in its Morbidity and Mortality Weekly Report (MMWR) on November 5. During 2023-2024, level IV NICUs in Michigan and New York each detected a cluster, with five extremely preterm infants (gestational age under 28 weeks) diagnosed in total. One infant in Michigan died; all three infants in New York survived. Neither investigation identified a definitive environmental source.
The Michigan cluster occurred in October-November 2023. Two extremely preterm neonates born at under 24 weeks' gestation developed skin lesions in their first week of life, and cultures from both grew Aspergillus fumigatus. Both received amphotericin B; the first infant died in the second week of life, with death attributed to septic shock from aspergillosis, Pseudomonas infection and extreme prematurity. An air sample collected near a corridor used for linen transport also grew A. fumigatus. The facility converted negative-pressure areas in the shared nursery to positive pressure to reduce airborne spore transmission, repaired plumbing leaks and flooring, and designated a separate loading dock for clean linens and supplies.
The New York cluster occurred in July-September 2024. Three extremely preterm neonates were diagnosed, born at 24-25 weeks, 24-25 weeks and under 24 weeks of gestation. Isolates were A. fumigatus in one case and the closely related Aspergillus quadrilineatus in two. The three infants were treated with micafungin, voriconazole plus amphotericin B, and amphotericin B, respectively, and all survived. That facility did not conduct environmental sampling; its measures included added linen-dryness checks, replacing some laundered linens with sterile towels, disposable positioning devices for extremely preterm neonates, sterile gloves for care during the first four days of life, and proactive replacement of high-efficiency particulate air filters. As of September 1, 2026, no additional cases had been identified in either NICU.
CDC says cutaneous aspergillosis can be life-threatening in extremely preterm neonates, whose immune defenses are immature, whose skin barriers are underdeveloped, and who are frequently exposed to invasive medical devices. Clinicians should consider the infection when extremely preterm infants develop new red, ulcerated, necrotic or otherwise suspicious skin lesions, obtain prompt cultures or biopsies with species-level identification, and coordinate assessment with infection prevention staff, facility engineers and public health agencies; mitigation should not wait for a definitive source to be found.
来源：美国疾病控制与预防中心
发布：GSM·美国（发布链接）
图片来源：图：新生儿重症监护室保育箱资料图（非涉事医院）。摄影 Manu Dias / AGECOM，CC BY 2.0，来源 Wikimedia Commons。 / Photo: Infant incubators in a neonatal intensive care unit (representative image; not a facility named in the report). Photo by Manu Dias / AGECOM, CC BY 2.0, via Wikimedia Commons.
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