Endoscopic Retrograde Cholangiopancreatography-Associated AmpC Escherichia coli Outbreak
Endoscopic Retrograde Cholangiopancreatography-Associated AmpC Escherichia coli Outbreak
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DOI：
10.1017/ice.2015.66
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发表时间：
2015-06-01
影响因子：
4.5
通讯作者：
Duchin, Jeffrey
中科院分区：
文献类型：
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作者：
Wendorf, Kristen A.;Kay, Meagan;Duchin, Jeffrey
背景我们在2012年11月至2013年8月期间在A医院接受内镜逆行胰胆管造影术的7名患者中发现了对第三代头孢菌素和碳青霉烯类（CR）耐药的产AmpC大肠埃希菌感染的爆发。基因测序揭示了bla（CMY）基因中一个共同的新突变和一个独特的fumC/fimH分型特征。确定暴发的程度和流行病学特征，确定潜在的传播源，设计和实施感染控制措施，并确定CRE之间的关联。coli和AmpC E.大肠杆菌在医院A.方法。我们回顾了实验室、医疗和内窥镜检查报告以及内窥镜再处理程序。我们从再处理后的内窥镜以及环境样本中获得培养物，并对来自患者和内窥镜的表型AmpC分离株进行脉冲场凝胶电泳和基因测序。病例是感染表型AmpC分离株（碳青霉烯敏感和CR）和相同bla（CMY-2）、fumC和fimH等位基因或相关脉冲场凝胶电泳图谱的病例。49 AmpC E.检测的大肠杆菌符合病例定义，包括所有CR分离株。所有病例均患有复杂的胆道疾病，并在A医院接受了至少1次内镜逆行胰胆管造影术。所有患者30天时的死亡率为16%，CR患者为56%。8个再处理内镜逆行胰胆管造影镜中有2个含有AmpC，其与通过脉冲场凝胶电泳分离的病例相匹配。环境培养呈阴性。没有发现感染控制方面的漏洞。内镜再处理超出了制造商推荐的清洁指南。推荐的再处理指南是不够的。
BACKGROUND. We identified an outbreak of AmpC-producing Escherichia coli infections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012-August 2013. Gene sequencing revealed a shared novel mutation in a bla(CMY) gene and a distinctive fumC/fimH typing profile.OBJECTIVE. To determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CR E. coli and AmpC E. coli circulating at hospital A.METHODS. We reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenemsusceptible and CR) and identical bla(CMY-2), fumC, and fimH alleles or related pulsed-field gel electrophoresis patterns.RESULTS. Thirty-five of 49 AmpC E. coli tested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer's recommended cleaning guidelines.CONCLUSION. Recommended reprocessing guidelines are not sufficient.