New Delhi Metallo-β-Lactamase-Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes
New Delhi Metallo-β-Lactamase-Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes
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DOI：
10.1001/jama.2014.12720
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发表时间：
2014-10-08
影响因子：
120.7
通讯作者：
Kallen, Alexander J.
中科院分区：
文献类型：
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作者：
Epstein, Lauren;Hunter, Jennifer C.;Kallen, Alexander J.
重要性产新德里金属β-内酰胺酶（NDM）的耐碳青霉烯类肠杆菌科（CRE）在美国很少见，但有可能增加CRE负担。以前的NDM-producing CRE集群已被归因于人与人之间的传播在health care facilities. ObjectiveTo identify a source for，and interrupt transmission of，NDM-producing CRE in a northeastern Illinois hospital.Design，SETING，AND Participants在伊利诺斯州东北部的一家三级保健医院的39例患者中进行暴发调查，包括病例对照研究，感染控制评估，并收集环境和器械培养物;使用脉冲场凝胶电泳（PFGE）评估患者和环境分离株的相关性。识别可能的来源后，有针对性的患者通知和CRE筛选cultured.Main结局和措施之间的关联接触和收购的NDM生产CRE;环境培养和微生物typing.Results的结果，共确定了39例患者从2013年1月至2013年12月，35与十二指肠镜暴露在1家医院。未发现十二指肠镜再处理的失误;然而，从再处理的十二指肠镜中回收了产NDM大肠埃希菌，并且通过PFGE与所有病例患者分离株的相似性超过92%。基于病例对照研究，病例患者暴露于十二指肠镜的几率显著更高（比值比[OR]，78 [95%CI，6.0-1008]，P < .001）。后医院改变了其再处理程序，从自动高水平的消毒与邻苯二甲醛气体灭菌与环氧乙烷，没有额外的情况下patients被identified.CONCLUSIONS和RELEVANCE在这次调查中，暴露于内窥镜细菌污染与明显的NDM生产大肠杆菌在1家医院的患者之间的传输。尽管没有公认的再处理失误，但内窥镜的细菌污染似乎持续存在。机构应了解细菌（包括耐药性微生物）通过该途径传播的可能性，并应定期审查其十二指肠镜再处理程序，以确保最佳手动清洁和消毒。
IMPORTANCE Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-beta-lactamase (NDM) are rare in the United States, but have the potential to add to the increasing CRE burden. Previous NDM-producing CRE clusters have been attributed to person-to-person transmission in health care facilities.OBJECTIVE To identify a source for, and interrupt transmission of, NDM-producing CRE in a northeastern Illinois hospital.DESIGN, SETTING, AND PARTICIPANTS Outbreak investigation among 39 case patients at a tertiary care hospital in northeastern Illinois, including a case-control study, infection control assessment, and collection of environmental and device cultures; patient and environmental isolate relatedness was evaluated with pulsed-field gel electrophoresis (PFGE). Following identification of a likely source, targeted patient notification and CRE screening cultures were performed.MAIN OUTCOMES AND MEASURES Association between exposure and acquisition of NDM-producing CRE; results of environmental cultures and organism typing.RESULTS In total, 39 case patients were identified from January 2013 through December 2013, 35 with duodenoscope exposure in 1 hospital. No lapses in duodenoscope reprocessing were identified; however, NDM-producing Escherichia coli was recovered from a reprocessed duodenoscope and shared more than 92% similarity to all case patient isolates by PFGE. Based on the case-control study, case patients had significantly higher odds of being exposed to a duodenoscope (odds ratio [OR], 78 [95% CI, 6.0-1008], P < .001). After the hospital changed its reprocessing procedure from automated high-level disinfection with ortho-phthalaldehyde to gas sterilization with ethylene oxide, no additional case patients were identified.CONCLUSIONS AND RELEVANCE In this investigation, exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producing E coli among patients at 1 hospital. Bacterial contamination of duodenoscopes appeared to persist despite the absence of recognized reprocessing lapses. Facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route and should conduct regular reviews of their duodenoscope reprocessing procedures to ensure optimal manual cleaning and disinfection.