DiazGranados Carlos A, Jones Marolyn Y, Kongphet-Tran Thiphasone, White Nancy, Shapiro Mark, Wang Yun F, Ray Susan M, Blumberg Henry M
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Infect Control Hosp Epidemiol. 2009 Jun;30(6):550-5. doi: 10.1086/597235.
A cluster of patients with respiratory cultures positive for Pseudomonas aeruginosa with a unique antibiogram was observed during June and July 2007 at a 1,000-bed urban teaching hospital in Atlanta, Georgia. These P. aeruginosa isolates were recovered from bronchoscopically obtained specimens.
A cross-sectional study was performed to assess whether the cluster was associated with exposure to a particular bronchoscope (B1); cultures from specimens from the bronchoscopes and the environment were obtained, and the P. aeruginosa isolate type was determined using pulsed-field gel electrophoresis (PFGE). Records of patients exposed to B1 during the cluster period were reviewed.
Twelve patients with a culture positive for P. aeruginosa with the unique susceptibility pattern were identified in June-July 2007. No cases were documented from March 1 through May 31, 2007. Culture specimens obtained from B1 after high-level disinfection revealed P. aeruginosa, prompting removal of B1 from service on July 23, 2007. No cases occurred after that date. Eleven (55%) of 20 patients who were exposed to B1 during the cluster period had a culture positive for P. aeruginosa, compared with 1 (2%) of 53 patients who were exposed to other bronchoscopes (P < .001). PFGE patterns for P. aeruginosa isolates obtained from case patients and from B1 were identical. An engineering evaluation of B1 documented several internal damages. Two (10.5%) of 19 patients exposed to B1 during the cluster period may have developed P. aeruginosa infection following exposure to B1.
An outbreak or pseudo-outbreak of P. aeruginosa infection occurred in association with use of a damaged bronchoscope. Periodic engineering maintenance may be needed to prevent bronchoscope contamination that is resistant to high-level disinfection.
2007年6月至7月期间，在佐治亚州亚特兰大市一家拥有1000张床位的城市教学医院，观察到一群呼吸道培养物中铜绿假单胞菌呈阳性且具有独特抗菌谱的患者。这些铜绿假单胞菌分离株是从通过支气管镜获取的标本中分离出来的。
进行了一项横断面研究，以评估该集群是否与接触特定支气管镜（B1）有关；获取了支气管镜和环境标本的培养物，并使用脉冲场凝胶电泳（PFGE）确定铜绿假单胞菌分离株类型。回顾了集群期间接触B1的患者记录。
2007年6月至7月期间，确定了12例铜绿假单胞菌培养阳性且具有独特药敏模式的患者。2007年3月1日至5月31日期间无病例记录。在高水平消毒后从B1获取的培养标本显示有铜绿假单胞菌，促使B1于2007年7月23日停止使用。自该日期之后未再出现病例。集群期间接触B1的20例患者中有11例（55%）铜绿假单胞菌培养呈阳性，而接触其他支气管镜的53例患者中有1例（2%）呈阳性（P <.001）。从病例患者和B1获得的铜绿假单胞菌分离株的PFGE模式相同。对B1的工程评估记录了几处内部损坏。集群期间接触B1的19例患者中有2例（10.5%）可能在接触B1后发生了铜绿假单胞菌感染。
与使用受损支气管镜相关的铜绿假单胞菌感染暴发或假暴发发生。可能需要定期进行工程维护，以防止支气管镜受到高水平消毒仍无法杀灭的污染。
