Corne P, Godreuil S, Jean-Pierre H, Jonquet O, Campos J, Jumas-Bilak E, Parer Sylvie, Marchandin H
Service de Réanimation Médicale Assistance Respiratoire, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier, France.
J Hosp Infect. 2005 Sep;61(1):20-6. doi: 10.1016/j.jhin.2005.01.024.
Between January and April 2003, a sudden increase in positive respiratory tract specimens for Pseudomonas aeruginosa was observed in an intensive care unit of the University Teaching Hospital of Montpellier, France. Most of the strains were cultured from bronchoalveolar lavage fluid samples, suggesting that bronchoscopic procedures could be implicated. The relationships between isolates were investigated by antibiotyping and pulsed-field gel electrophoresis. Both phenotypic and molecular markers allowed identification of two consecutive nosocomial outbreaks of respiratory infections related to two different bronchoscopes. These two outbreaks implicated nine and seven patients, respectively. Four of these 16 patients had true infections and recovered with antibiotic therapy. Inspection of both bronchoscopes revealed a damaged internal channel caused by defective biopsy forceps. These defects led to improper cleaning and disinfection of the bronchoscopes despite adherence to all current reprocessing procedures. The two outbreaks were controlled after replacing the inner channels of the bronchoscopes and switching from use of re-usable to disposable biopsy forceps. These outbreaks emphasize the need to establish surveillance procedures for detecting contamination of bronchoscopes, and the importance of recording each endoscopic procedure to facilitate further investigations if needed.
2003年1月至4月期间，法国蒙彼利埃大学教学医院的一个重症监护病房中，呼吸道标本中铜绿假单胞菌呈阳性的情况突然增加。大多数菌株是从支气管肺泡灌洗液体样本中培养出来的，这表明支气管镜检查程序可能与此有关。通过抗菌谱分型和脉冲场凝胶电泳研究了分离株之间的关系。表型和分子标记均能识别出与两台不同支气管镜相关的两起连续的医院内呼吸道感染暴发。这两起暴发分别涉及9名和7名患者。这16名患者中有4名发生了真正的感染，并通过抗生素治疗康复。对两台支气管镜的检查发现活检钳有缺陷导致内部通道受损。尽管严格遵守了所有现行的再处理程序，但这些缺陷仍导致支气管镜的清洁和消毒不当。更换支气管镜的内部通道并从使用可重复使用的活检钳改为一次性活检钳后，这两起暴发得到了控制。这些暴发强调了建立监测程序以检测支气管镜污染的必要性，以及记录每一次内镜检查程序以便在需要时便于进一步调查的重要性。
