El Helali N, Carbonne A, Naas T, Kerneis S, Fresco O, Giovangrandi Y, Fortineau N, Nordmann P, Astagneau P
Medical Biology Department, Hôpital Notre Dame de Bon Secours, Paris, France.
J Hosp Infect. 2005 Oct;61(2):130-8. doi: 10.1016/j.jhin.2005.02.013.
Over a three-month period, 13 neonates developed staphylococcal scalded skin syndrome (SSSS) in a maternity unit, between four and 18 days after their birth. An epidemiological and descriptive study followed by a case-control study was performed. A case was defined as a neonate with blistering or peeling skin, and exfoliative toxin A Staphylococcus aureus positive cultures. Controls were selected at random from the asymptomatic, non-colonized neonates born on the same day as the cases. All staff members and all neonates born during the outbreak period were screened for carriage by nasal swabs and umbilical swabs, respectively. S. aureus isolates were polymerase chain reaction (PCR) screened for etA gene and genotyped by pulsed-field gel electrophoresis (PFGE). Two clusters of eight and five cases were identified. Receiving more than one early umbilical care procedure by the same ancillary nurse was the only risk factor identified in the case-control study (odds ratio=15, 95% confidence intervals 2-328). The ancillary nurse suffered from chronic dermatitis on her hands that favoured S. aureus carriage. Exfoliative-toxin-A-producing strains, as evidenced by PCR and indistinguishable by PFGE, were isolated from all but one of the SSSS cases, from four asymptomatic neonates, from two staff members and from the ancillary nurse's hands. Removal of the ancillary nurse from duty, infection control measures (isolation precautions, chlorhexidine handwashing and barrier protections), and treatment of the carriers (nasal mupirocin and chlorhexidine showers) led to control of the epidemic. In conclusion, this study emphasizes the need for tight surveillance of chronic dermatitis in healthcare workers.
在三个月的时间里，一家产科病房有13名新生儿在出生后4至18天内患上了葡萄球菌烫伤样皮肤综合征（SSSS）。随后进行了一项流行病学描述性研究，接着是病例对照研究。病例定义为皮肤出现水疱或脱皮且金黄色葡萄球菌剥脱毒素A培养呈阳性的新生儿。对照是从与病例同一天出生的无症状、未定植的新生儿中随机挑选的。分别通过鼻拭子和脐拭子对疫情暴发期间的所有工作人员和所有新生儿进行了定植筛查。对金黄色葡萄球菌分离株进行聚合酶链反应（PCR）检测以筛查etA基因，并通过脉冲场凝胶电泳（PFGE）进行基因分型。确定了两个聚集性病例群，分别为8例和5例。病例对照研究中确定的唯一风险因素是同一名辅助护士进行了不止一次早期脐带护理操作（比值比=15，95%置信区间2 - 328）。该辅助护士手部患有慢性皮炎，这有利于金黄色葡萄球菌的携带。除1例SSSS病例外，从所有SSSS病例、4例无症状新生儿、2名工作人员以及该辅助护士的手部均分离出了经PCR证实产生剥脱毒素A且PFGE分型无法区分的菌株。让该辅助护士停职、采取感染控制措施（隔离预防措施、洗必泰洗手和屏障保护）以及对携带者进行治疗（鼻腔使用莫匹罗星和洗必泰淋浴）使疫情得到了控制。总之，本研究强调了对医护人员慢性皮炎进行严格监测的必要性。
