Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa
Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa
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DOI：
10.1001/jamanetworkopen.2018.7665
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发表时间：
2019-02-01
影响因子：
13.8
通讯作者：
Wertheim, Heiman F. L.
中科院分区：
文献类型：
--
作者：
Hopman, Joost;Meijer, Corianne;Wertheim, Heiman F. L.
革兰氏阴性杆菌对碳青霉烯类的耐药性在全球范围内迅速出现。2016年，世界卫生组织将医院建筑环境定义为感染预防和控制计划的核心组成部分。最近有报道称，医院建筑环境是产生碳青霉烯酶的革兰氏阴性杆菌从环境到患者的爆发和散发传播事件的来源。目的：在碳青霉烯酶低流行性环境中，确定由产生碳青霉烯酶的铜绿假单胞菌引起的意外、严重和致死性医院获得性感染后，评估风险。和参与者一项病例系列研究，其中对所有11名入住荷兰Radboud大学医学中心心胸外科和肺部疾病联合病房和医院建筑环境的患者进行了风险评估，2018年2月。暴露含有产碳青霉烯酶的水和气溶胶（Verona整合子介导的金属β-内酰胺酶[Vim]）铜绿假单胞菌。主要结果和指标1例患者检测到产碳青霉烯酶（Vim）铜绿假单胞菌感染后，或环境污染。结果共有5名男性（年龄范围，60-84岁）和6名女性（年龄范围，55-74岁）入住心胸外科和肺部疾病联合病房。风险评估是在一名60岁出头的男子意外检测到产碳青霉烯酶（Vim）铜绿假单胞菌后进行的，该男子接受了左侧肺切除术和辅助放疗。未检测到产碳青霉烯酶（Vim）铜绿假单胞菌的其他病例（定植或感染）。通过全基因组测序证实了从医院环境中通过空气向患者传播产碳青霉烯酶铜绿假单胞菌的可能性，这证明了来自患者的假单胞菌菌株，8个病房的淋浴排水管，1个水槽和空气样本的关系。对于预防严重和潜在致命的医院感染至关重要。
IMPORTANCE Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients.OBJECTIVE To assess risk after the identification of an unexpected, severe, and lethal hospital-acquired infection caused by carbapenemase-producing Pseudomonas aeruginosa in a carbapenemase-low endemic setting.DESIGN, SETTINGS, AND PARTICIPANTS A case series study in which a risk assessment was performed on all 11 patients admitted to the combined cardiothoracic surgery and pulmonary diseases ward and the hospital-built environment in the Radboud University Medical Center, the Netherlands, in February 2018.EXPOSURES Water and aerosols containing carbapenemase-producing (Verona integron-mediated metallo-beta-lactamase [VIM]) P aeruginosa.MAIN OUTCOMES AND MEASURES Colonization and/or infection of patients and/or contamination of the environment after the detection of 1 patient infected with carbapenemase-producing (VIM) P aeruginosa.RESULTS A total of 5 men (age range, 60-84 years) and 6 women (age range, 55-74 years) were admitted to the combined cardiothoracic surgery and pulmonary diseases ward. The risk assessment was performed after carbapenemase-producing (VIM) P aeruginosa was unexpectedly detected in a man in his early 60s, who had undergone a left-sided pneumonectomy and adjuvant radiotherapy. No additional cases (colonization or infection) of carbapenemase-producing (VIM) P aeruginosa were detected. Plausible transmission of carbapenemase-producing P aeruginosa from the hospital environment to the patient via the air was confirmed by whole-genome sequencing, which proved the relation of Pseudomonas strains from the patient, the shower drains in 8 patient rooms, 1 sink, and an air sample.CONCLUSIONS AND RELEVANCE This study suggests that rethinking the hospital-built environment, including shower drains and the sewage system, will be crucial for the prevention of severe and potential lethal hospital-acquired infections.