Adjidé C C, Li-Thiao-Te V, Biendo M, Weibel B, Laurans G, Krim G, Eb F
Unité d'hygiène hospitalière et de prévention des infections nosocomiales, CHU Amiens, hôpital Nord, place Victor-Pauchet, 80054 Amiens, France.
Pathol Biol (Paris). 2004 Oct;52(8):423-8. doi: 10.1016/j.patbio.2004.07.019.
To identify patient-related risk factors of infection and ways of transmission of extended-spectrum betalactamase (ESBL) producing Serratia marcescens in the paediatric intensive care unit (PICU) of Amiens university hospital (France) between June and July 2002.
Five cases (four pulmonary infected and one stool contaminated symptom-free neonates) and 35 controls, admitted in the PICU, are included. S. marcescens ESBL analysed are isolated from respiratory tract and faecal samples for cases and urine and pus samples from two non-paediatric other patients. Univariate and multivariate analysis are performed on EPI INFO 6.04 dFr and SPSS 11.0.1.
S. marcescens ESBL infections or colonisations rate is 12.5% [4.7-27.6]. The incidence is 8.8 [6.7-11.6] per 1000 hospital-stay days. By univariate analysis, cases and controls don't differ with respect of age, sex, and weight at admission or preterm delivery. Cases don't have more often invasive nursing care than controls. But, they were intubated (P <0.03) and hospitalised (P <0.03) for a longer time than controls. Linear regression analysis showed that duration of intubation was independent predictor of acquisition of S. marcescens ESBL (P <0.008). S. marcescens ESBL strains implicated in pulmonary infections, showed the same pattern of multidrug resistant and ERIC-PCR profile. This clone differs from others isolated from stool or other samples from other hospital wards.
As S. marcescens cross-colonization appears to be due to lake of hand hygiene and asepsis during invasive nursing care, reinforcing hygiene measures permit to contain the outbreak.
确定2002年6月至7月间法国亚眠大学医院儿科重症监护病房（PICU）中与感染相关的患者风险因素以及产超广谱β-内酰胺酶（ESBL）的粘质沙雷氏菌的传播途径。
纳入了PICU收治的5例患者（4例肺部感染患者和1例粪便污染但无症状的新生儿）和35例对照。对所分析的产ESBL粘质沙雷氏菌，病例组从呼吸道和粪便样本中分离，对照组从两名非儿科其他患者的尿液和脓液样本中分离。使用EPI INFO 6.04 dFr和SPSS 11.0.1进行单因素和多因素分析。
产ESBL粘质沙雷氏菌感染或定植率为12.5%[4.7 - 27.6]。发病率为每1000个住院日8.8[区间6.7 - 11.6]。单因素分析显示，病例组和对照组在入院时的年龄、性别、体重或早产方面无差异。病例组接受侵入性护理的频率并不比对照组高。但是，他们插管时间（P<0.03）和住院时间（P<0.03）比对照组更长。线性回归分析表明，插管时间是获得产ESBL粘质沙雷氏菌的独立预测因素（P<0.008）。与肺部感染相关的产ESBL粘质沙雷氏菌菌株显示出相同的多重耐药模式和ERIC-PCR图谱。该克隆与从其他医院病房的粪便或其他样本中分离出的其他菌株不同。
由于产ESBL粘质沙雷氏菌的交叉定植似乎是由于侵入性护理过程中手部卫生和无菌操作不到位所致，加强卫生措施有助于控制疫情暴发。
