Children's Hospital Medical Center, University of Bonn, Bonn, Germany.
Int J Hyg Environ Health. 2010 Mar;213(2):79-87. doi: 10.1016/j.ijheh.2009.09.003. Epub 2009 Sep 26.
The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality. The clinical observation of two or more temporally related cases of nosocomial S. marcescens infection should raise the suspicion of an outbreak, particularly in the NICU or PICU setting. Since colonized or infected patients represent the most important reservoir for cross transmission, hygienic barrier precautions (contact isolation/cohortation, the use of gloves and gowns in addition to strictly performed hand disinfection, enhanced environmental disinfection) should immediately be implemented and staff education given. Well-planned sampling of potential environmental sources should only be performed when these supervised barrier precautions do not result in containment of the outbreak. The current strategy of empiric antibiotic treatment should be reevaluated by a medical microbiologist or an infectious disease specialist. Empiric treatment of colonized children should use combination therapy informed by in vitro susceptibility data; in this context the high propensity of S. marcescens to cause meningitis and intracerebral abscess formation should be considered. In vitro susceptibility patterns do not reliably prove or exclude the clonality of the outbreak isolate. Genotyping of the isolates by pulse-field gel electrophoresis or PCR-based methods should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results.
以下建议源自对 27 篇文献中描述的 34 起阴沟肠杆菌爆发的系统分析，这些文献来自新生儿和儿科重症监护病房（NICU、PICU），其中使用基因分型方法来确认或排除克隆性。在 NICU 或 PICU 环境中，应怀疑出现两例或多例与医院获得性阴沟肠杆菌感染相关的临床观察，特别是在 NICU 或 PICU 环境中。由于定植或感染患者是交叉传播最重要的传染源，因此应立即实施卫生屏障预防措施（接触隔离/分组、戴手套和长袍，除了严格进行手部消毒外，还应加强环境消毒），并对工作人员进行教育。只有在这些监督屏障预防措施不能控制疫情爆发时，才应进行潜在环境源的有计划采样。应通过医学微生物学家或传染病专家重新评估当前经验性抗生素治疗策略。对定植儿童的经验性治疗应根据体外药敏数据使用联合治疗；在这种情况下，应考虑阴沟肠杆菌引起脑膜炎和脑内脓肿形成的高倾向。体外药敏模式不能可靠地证明或排除爆发分离株的克隆性。应通过脉冲场凝胶电泳或基于 PCR 的方法对分离株进行基因分型，但在等待结果之前，应进行任何干预措施以阻止进一步的医院内传播。
