Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center.
Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center.
复制标题
铜绿假单胞菌和肺炎肺炎肺炎血流感染的爆发在门诊化疗中心。
DOI：
10.1016/j.ajic.2014.03.007
复制
发表时间：
2014-07
影响因子：
4.9
通讯作者：
Byers P
中科院分区：
文献类型：
--
作者：
Dobbs TE;Guh AY;Oakes P;Vince MJ;Forbi JC;Jensen B;Moulton-Meissner H;Byers P
2011年7月，4例患者因铜绿假单胞菌血流感染（BSI）住院，其中2例还患有肺炎克雷伯菌BSI。所有4例患者均在同一肿瘤门诊中心接受留置输液港和输液服务。病例定义为2011年7月5日至20日期间在肿瘤门诊接受输液服务的患者中肺炎克雷伯菌或铜绿假单胞菌的血液或输液港培养阳性。对可用的分离株进行脉冲场凝胶电泳（PFGE）。与工作人员的访谈和现场调查发现了感染控制措施的失误。由于对长期缺陷的担忧，2008年1月至2011年7月期间在诊所就诊的在世患者被通知进行病毒性血源性病原体检测;通过分子检测确定遗传相关性。在84例活跃的临床患者中确定了14例（17%），其中12例涉及BSI症状。另1例患者呼吸道培养铜绿假单胞菌阳性，但在获得血培养前死亡。可用的分离株通过PFGE无法区分。发现了多处注射安全性失误，包括患者之间明显的注射器重复使用和注射器重复使用以获得共享药物。在623例通知的患者中，331例（53%）的可用BBP结果未显示医源性病毒感染。注射药物的不当准备和处理可能导致爆发。加强对肿瘤诊所的感染控制监督对于防止类似疫情至关重要。
Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center. Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing. Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%). Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.
登录
查看更多内容
影响因子：
39.2
作者：
de Oliveira, AM;White, KL;Safranek, TJ
通讯作者：
Safranek, TJ
影响因子：
3.1
作者：
Ramachandran, Sumathi;Xia, Guo-liang;Khudyakov, Yury
通讯作者：
Khudyakov, Yury
影响因子：
5.1
作者：
Perz, Joseph F;Thompson, Nicola D;Patel, Priti R
通讯作者：
Patel, Priti R
影响因子：
4.9
作者：
Radcliffe, Rachel;Meites, Elissa;Patel, Priti R.
通讯作者：
Patel, Priti R.
影响因子：
3.8
作者：
Forbi, Joseph C.;Purdy, Michael A.;Khudyakov, Yury E.
通讯作者：
Khudyakov, Yury E.