Outbreak of Hospital Infection from Biofilm-embedded Pan Drug-resistant Pseudomonas aeroginosa, Due to a Contaminated Bronchoscope.
Outbreak of Hospital Infection from Biofilm-embedded Pan Drug-resistant Pseudomonas aeroginosa, Due to a Contaminated Bronchoscope.
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DOI：
10.21767/2572-5483.100014
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Durmaz, Riza
中科院分区：
文献类型：
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作者：
Alipour, Nader;Karagoz, Alper;Durmaz, Riza
背景：耐粘菌素铜绿假单胞菌（P. aeruginosa）已被定义为普遍耐药（PDR）菌株。PDR铜绿假单胞菌的暴发，特别是由于污染的支气管镜引起的肺部感染，很少有报道。近年来，CF（囊性纤维化）和非CF临床分离株中出现的普遍耐药菌株仍然是一个很大的问题。被PDR铜绿假单胞菌感染污染的医院病房，必须被击落，直到它们被根除。必须立即通知卫生当局，并实施感染控制战略。目的：报告土耳其安卡拉某学术医院的此类暴发并修改感染控制策略。方法：2013年10 - 12月，对15例患者的支气管培养物进行pdr -气吸假单胞菌鉴定。从与程序相关的环境对象和医护人员中获得了三批监测培养物。采用脉冲场凝胶电泳（PFGE）进行细菌分型。采用纸片扩散法和e -试验法评价药敏。结果：首次监测共采集标本70份。从支气管镜中分离出一株耐粘菌素的铜绿假单胞菌。虽然修订并实施了支气管镜消毒方案，但此后又发现了7例支气管病例。从随后的两次监测培养中鉴定出病原体，直到在消毒方案中加入环氧乙烷灭菌才能消除病原体。PFGE显示患者的15株分离株和支气管镜的3株分离株具有共同的模式，差异较小。在bionumics 6.0中，XbaI限制性内切酶比SpeI更能解释细菌脉冲类型。SpeI与bionumics 6.0的Dice相似度在80%以上，XbaI与bionumics 6.0的Dice相似度在95%以上是最合适的临界值。结论：此次“粘菌素”泛耐药铜绿假单胞菌的暴发是由污染的支气管镜引起的，并通过实施修订后的支气管镜消毒方案得以终止。
Background: Colistin-resistant Pseudomonas aeruginosa (P. aeruginosa) has been defined as pandrug-resistant (PDR) strain. Outbreaks of PDR P. aeruginosa especially in pulmonary tract infections due to contaminated bronchoscopes have rarely been reported. The emergence of pandrug-resistant strains in both CF (Cystic Fibrosis) and non-CF clinical isolates over recent years remains of a great concern. Hospital wards contaminated with PDR P. aeruginosa infection, must be shot down until their eradication. Health Authorities must be informed immediately and infection control strategies must be implemented.Aim: To report such an outbreak and modify the infection control strategy in an academic hospital in Ankara Turkey.Methods: From October to December 2013, PDR-Pseudomonas aerogionsa were identified from bronchial cultures of 15 patients who had undergone bronchoscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods.Findings: A total of 70 specimens were obtained during the first surveillance operation. One Colistin-resistant P. aeroginosa was isolated from a bronchoscope. Although the disinfection protocols for bronchoscope were revised and implemented, seven additional bronchial cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until Ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the bronchoscope shared a common pattern with minor variance. XbaI restriction enzyme turned out better than SpeI in interpreting bacterial pulse types with BioNumerics 6.0. The most suitable cut off value for SpeI was above 80% Dice similarity while for XbaI above 95%Dice similarity with BioNumerics 6.0.Conclusion: The outbreak of "Colistin" pan drug-resistant Pseudomonas aeroginosa was caused by a contaminated bronchoscope and was terminated by the implementation of a revised disinfection protocol for bronchoscope.