Sorin M, Segal-Maurer S, Mariano N, Urban C, Combest A, Rahal J J
Department of Medicine, New York Hospital Medical Center of Queens, Flushing 11355, USA.
Infect Control Hosp Epidemiol. 2001 Jul;22(7):409-13. doi: 10.1086/501925.
To assess nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa (IRPA) following bronchoscopy during August through October 1998.
Traditional and molecular epidemiological investigation of a case series.
University-affiliated community hospital.
18 patients with IRPA bronchial-wash isolates.
We reviewed clinical data, performed environmental cultures and molecular analysis of all IRPA isolates, and observed disinfection of bronchoscopes.
Of 18 patients who had IRPA isolated from bronchoscopic or postbronchoscopic specimens, 13 underwent bronchoscopy for possible malignancy or undiagnosed pulmonary infiltrates. Following bronchoscopy, 3 patients continued to have IRPA isolated from sputum and demonstrated clinical evidence of infection requiring specific antimicrobial therapy. The remaining 15 patients had no further IRPA isolated and remained clinically well 3 months following bronchoscopy. Pulsed-field gel electrophoresis revealed that all strains except one were >95% related. STERIS SYSTEM 1 had been implemented in July 1998 as an automatic endoscope reprocessor (AER) for all endoscopes and bronchoscopes. Inspection of bronchoscope sterilization cycles revealed incorrect connectors joining the bronchoscope suction channel to the STERIS SYSTEM 1 processor, obstructing peracetic acid flow through the bronchoscope lumen. No malfunction warning was received, and spore strips remained negative.
The similarity of diverse connectors and limited training by the manufacturer regarding AER for bronchoscopes were the two factors responsible for the outbreak. Appropriate connections were implemented, and there was no further bronchoscope contamination. We suggest active surveillance of all bronchoscopy specimen cultures, standardization of connectors of various scopes and automated processors, and systematic education of staff by manufacturers with periodic on-site observation.
评估1998年8月至10月支气管镜检查后耐亚胺培南铜绿假单胞菌（IRPA）的医院内传播情况。
对一系列病例进行传统和分子流行病学调查。
大学附属医院。
18例支气管冲洗液分离出IRPA的患者。
我们回顾了临床数据，对所有IRPA分离株进行了环境培养和分子分析，并观察了支气管镜的消毒情况。
18例支气管镜检查或支气管镜检查后标本中分离出IRPA的患者，13例因可能的恶性肿瘤或未确诊的肺部浸润接受支气管镜检查。支气管镜检查后，3例患者痰液中继续分离出IRPA，并显示有需要特定抗菌治疗的感染临床证据。其余15例患者未再分离出IRPA，支气管镜检查后3个月临床状况良好。脉冲场凝胶电泳显示，除1株外，所有菌株的相关性均>95%。1998年7月实施了STERIS SYSTEM 1作为所有内镜和支气管镜的自动内镜处理器（AER）。对支气管镜消毒周期的检查发现，连接支气管镜吸引通道与STERIS SYSTEM 1处理器的连接器不正确，阻碍了过氧乙酸流过支气管镜管腔。未收到故障警告，芽孢条仍为阴性。
不同连接器的相似性以及制造商对支气管镜AER培训有限是导致此次暴发的两个因素。实施了正确的连接，此后没有进一步的支气管镜污染。我们建议对所有支气管镜检查标本培养进行主动监测，规范各种内镜和自动处理器的连接器，并由制造商对工作人员进行系统教育并定期进行现场观察。
