Skoczyńska Anna, Sadowy Ewa, Krawiecka Dorota, Czajkowska-Malinowska Małgorzata, Ciesielska Anna, Przybylski Grzegorz, Zebracka Renata, Hryniewicz Waleria
Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warszawa, Poland.
Pol Arch Med Wewn. 2012;122(7-8):361-6. doi: 10.20452/pamw.1353. Epub 2012 Jul 3.
Streptococcus pneumoniae (S. pneumoniae) is one of the most common bacterial pathogens in community‑acquired pneumonia. However, nosocomial pneumococcal infections are more and more widely observed.
The aim of the study was to analyze nosocomial outbreak in one of the Polish hospitals and to characterize the causative isolates.
Within 10 days, in 6 patients receiving an antimicrobial therapy due to a primary disease, pneumococcal infections of the lower respiratory tract were identified. All patients, except 1 patient with asthma, were hospitalized due to exacerbation of chronic obstructive pulmonary disease (COPD). The isolates were identified by standard methods. The serotypes of S. pneumoniae were determined by the Pneumotest‑Latex kit. The relatedness among isolates was evaluated by restriction fragment length polymorphism followed by pulsed‑field gel electrophoresis (RFLP‑PFGE). Multilocus sequence typing (MLST) was performed for a representative isolate.
The outbreak was suspected when characteristic multidrug‑resistant pneumococci were isolated from patients of a single ward. The outbreak was confirmed by molecular typing techniques. All isolates belonged to serotype 14 and shared the RFLP‑PFGE pattern. MLST for a representative isolate revealed that it was a member of the epidemic Spain9V‑ST156 clonal complex.
Timely implementation of infection control measures enabled to eradicate the outbreak. Pneumococcal conjugate vaccine, recently registered for use in adult populations, may have a considerable effect on limiting pneumococcal disease‑associated morbidity and mortality. It is especially important for patients with COPD, a disease entity that constitutes a risk factor for the acquisition of multidrug‑resistant pneumococci.
肺炎链球菌是社区获得性肺炎中最常见的细菌病原体之一。然而，医院获得性肺炎链球菌感染的观察越来越广泛。
本研究旨在分析波兰一家医院的医院感染暴发情况，并对致病分离株进行特征分析。
在10天内，在6例因原发性疾病接受抗菌治疗的患者中，确诊为下呼吸道肺炎链球菌感染。除1例哮喘患者外，所有患者均因慢性阻塞性肺疾病（COPD）急性加重而住院。分离株通过标准方法鉴定。肺炎链球菌的血清型通过肺炎球菌乳胶试验试剂盒测定。通过限制性片段长度多态性分析，随后进行脉冲场凝胶电泳（RFLP-PFGE）评估分离株之间的相关性。对一株代表性分离株进行多位点序列分型（MLST）。
当从单个病房的患者中分离出具有特征性的多重耐药肺炎球菌时，怀疑发生了暴发。通过分子分型技术证实了暴发。所有分离株均属于14型血清型，并具有相同的RFLP-PFGE图谱。对一株代表性分离株的MLST分析表明，它是流行的西班牙9V-ST156克隆复合体的成员。
及时实施感染控制措施能够根除暴发。最近注册用于成人人群的肺炎球菌结合疫苗可能对限制肺炎球菌疾病相关的发病率和死亡率有相当大的作用。对于COPD患者尤为重要，COPD是获得多重耐药肺炎球菌的危险因素。
