Investigation of a Nosocomial Outbreak Due to Serratia marcescens in a Maternity Hospital
Investigation of a Nosocomial Outbreak Due to Serratia marcescens in a Maternity Hospital
复制标题
某妇产医院发生粘质沙雷氏菌院内暴发的调查
DOI：
--
复制
发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Philippe Fargier
中科院分区：
文献类型：
--
作者：
P. Berthelot;F. Grattard;Colette Amerger;Marie;F. Lucht;B. Pozzetto;Philippe Fargier
摘要目的：调查某妇产科医院1994年11月~ 1995年5月发生的一起粘质沙雷菌暴发疫情。设计图：回顾性分析流行病学数据和前瞻性研究的系统性细菌学样本的病人和环境，与基因分型菌株的任意引物聚合酶链反应。设置：一家私人妇产医院，圣艾蒂安，法国。结果：在新生儿病房，1名新生儿发生菌血症，36名新生儿粪便中定植粘质沙雷氏菌。由于一些新生儿在分娩后几个小时就被感染，调查扩大到其他产科病房，发现8名婴儿和4名母亲被感染。环境采样导致粘质沙雷氏菌从新生儿病房的一瓶肠内饲料添加剂和分娩室的两个内部分娩记录仪的换能器中分离。27株菌株的基因分型显示出两种不同的谱：22株菌株（18株来自新生儿病房的婴儿，2株来自其他病房的婴儿，2株来自母乳）共享的主要流行谱和5株菌株（2株来自内分娩力描记器的传感器，2株来自婴儿，1株来自母亲）共享的另一种谱。从脂肪肠内喂养分离的菌株无法用于分型。虽然这种污染源很快就从新生儿病房清除了，但只有在产房加强感染控制措施（包括禁止重复使用内部分娩记录仪）后，疫情才停止。结论：在产房，卫生质量需要与手术室一样高，以防止新生儿出生时医院定植或感染。
Abstract Objectives: To investigate an outbreak of Serratia marcescens in a maternity hospital (November 1994 to May 1995). Design: Retrospective analysis of epidemiological data and prospective study of systematic bacteriological samples from patients and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction. Setting: A private maternity hospital, Saint-Etienne, France. Results: In the neonatal unit, 1 newborn developed a bacteremia, and 36 were colonized in stools with S marcescens. As the colonization of some newborns was shown to occur only a few hours after delivery, the inquiry was extended to other maternity wards, where 8 babies and 4 mothers were found to be colonized. Environmental sampling led to the isolation of S marcescens from a bottle of enteral feed additive in the neonatal unit and from the transducers of two internal tocographs in the delivery rooms. The genotyping of 27 strains showed two different profiles: a major epidemic profile shared by 22 strains (18 from babies of the neonatal unit, 2 from babies of other units, and 2 from breast milk) and another profile shared by 5 strains (2 from transducers of internal tocographs, 2 from babies, and 1 from a mother). The strain isolated from lipid enteral feeding was not available for typing. Although this source of contamination was removed soon from the neonatal unit, the outbreak stopped only when infection control measures were reinforced in the delivery rooms, including the nonreuse of internal tocographs. Conclusions: In delivery rooms, the quality of hygiene needs to be as high as in surgery rooms to prevent nosocomial colonization or infection of neonates at birth.