Cukier L, Lutzler P, Bizien A, Avril J L
Service de Gérontologie 1, Hôpital Georges Clemenceau, Champcueil, France.
Pathol Biol (Paris). 1999 May;47(5):440-4.
An outbreak of extended-spectrum beta-lactamase-producing (ESBL) Escherichia coli urinary tract infection occurred on one floor of a department of the G. Clemenceau hospital. There were nine cases from March to August 1994, all of which resolved under antimicrobial therapy. Two further cases occurred, leading to a program of routine rectal swab cultures in all patients on the floor involved (first floor). ESBL E. coli carriage was found in six patients. Follow-up rectal swabs were obtained until September 1995 from all patients on the floor who were infected or colonized with ESBL E. coli between March and October 1994. Between March and June 1995, routine rectal swabs were also obtained from the patients on the other two floors of the department. Seven other carriers were detected and also underwent follow-up rectal swabs until September 1995. Ribotyping of the strains done at the national enteric molecular typing center (Pasteur Institute, Paris) demonstrated four patterns (CM1, CM2, CM3, and CM4). The strains from the first six carriers all shared the CM1 pattern, whereas among the seven carriers detected later, four (second and third floors) had a CM1 strain and the remaining three (first floor) each had a strain of the three other ribotypes (CM2, CM3, and CM4). ESBL E. coli can be carried in the digestive tract for several months. During the outbreak, the same strain was found in all the patients, whereas a variety of strains were found after the outbreak in patiens without clinical symptoms due to ESBL E. coli. Routine rectal swab cultures are useful for evaluating the extent of outbreaks. However, the only effective outbreak control measures are compliance with strict hygiene procedures (signalization, technical and geographic isolation) and appropriate antimicrobial therapy. These measures were effective at the G. Clemenceau Hospital since there have been no further cases of ESBL E. coli since they were implemented. The rectal swab program has therefore been stopped, whereas strict universal hygienic precautions are still adhered to faithfully.
在G.克莱门梭医院的一个科室楼层爆发了产超广谱β-内酰胺酶（ESBL）的大肠埃希菌尿路感染疫情。1994年3月至8月出现了9例病例，所有病例在抗菌治疗下均痊愈。又出现了2例病例，于是对该楼层（一楼）的所有患者开展了常规直肠拭子培养项目。在6名患者中发现了携带ESBL大肠埃希菌的情况。对1994年3月至10月期间在该楼层感染或定植有ESBL大肠埃希菌的所有患者持续采集随访直肠拭子，直至1995年9月。1995年3月至6月期间，还对该科室另外两层楼的患者进行了常规直肠拭子采集。又检测到7名携带者，并同样对其进行直肠拭子随访，直至1995年9月。在国家肠道分子分型中心（巴黎巴斯德研究所）对菌株进行的核糖体分型显示出四种模式（CM1、CM2、CM3和CM4）。前6名携带者的菌株均具有CM1模式，而在后来检测到的7名携带者中，4名（二楼和三楼）携带CM1菌株，其余3名（一楼）分别携带其他三种核糖体分型（CM2、CM3和CM4）的菌株。ESBL大肠埃希菌可在消化道中携带数月。疫情期间，所有患者均检测出相同菌株，而疫情过后，在无ESBL大肠埃希菌临床症状的患者中发现了多种菌株。常规直肠拭子培养有助于评估疫情的范围。然而，唯一有效的疫情控制措施是严格遵守卫生程序（张贴警示、技术和地域隔离）以及适当的抗菌治疗。这些措施在G.克莱门梭医院是有效的，自实施以来未再出现ESBL大肠埃希菌感染病例。因此，直肠拭子项目已停止，但仍严格忠实遵守普遍的卫生预防措施。
