Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin, Germany.
Infection. 2014 Feb;42(1):15-21. doi: 10.1007/s15010-013-0544-6. Epub 2013 Oct 29.
Two endoscopy-associated nosocomial outbreaks caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) were recently observed in two German hospitals. In this study, we performed a systematic search of the medical literature in order to elucidate the epidemiology of Klebsiella spp. in endoscopy-associated outbreaks.
Medline, the Outbreak Database ( http://www.outbreak-database.com ) and reference lists of articles extracted from these databases were screened for descriptions of endoscopy-associated nosocomial outbreaks. The data extracted and analysed were: (1) the type of medical department affected; (2) characterisation of pathogen to species and conspicuous resistance patterns (if applicable); (3) type of endoscope and the grade of its contamination; (4) number and the types of infections; (5) actual cause of the outbreak.
A total of seven nosocomial outbreaks were identified, of which six were outbreaks of endoscopic retrograde cholangiopancreatography-related infections and caused by contaminated duodenoscopes. Including our own outbreaks in the analysis, we identified one extended-spectrum beta-lactamase-producing K. pneumoniae strain and six CPKP strains. Insufficient reprocessing after the use of the endoscope was the main reason for subsequent pathogen transmission.
There were only two reports of nosocomial outbreaks due to Klebsiella spp. in the first three decades of endoscopic procedures, but seven additional outbreaks of this kind have been reported within the last 4 years. It is very likely that many of such outbreaks have been missed in the past because this pathogen belongs to the physiological gut flora. However, with the emergence of highly resistant (carbapenemase-producing) strains, strict adherence to infection control guidelines is more important than ever.
最近在两家德国医院观察到两起因产碳青霉烯酶肺炎克雷伯菌（CPKP）引起的内镜相关医院感染暴发。在这项研究中，我们系统地检索了医学文献，以阐明内镜相关暴发中肺炎克雷伯菌的流行病学。
共确定了 7 起医院感染暴发，其中 6 起为内镜逆行胰胆管造影相关感染暴发，由污染的十二指肠镜引起。包括我们自己的暴发在内，我们发现了 1 株产超广谱β-内酰胺酶肺炎克雷伯菌和 6 株 CPKP 株。内镜使用后处理不充分是后续病原体传播的主要原因。
在前 30 年的内镜检查中，仅有两起因肺炎克雷伯菌引起的医院感染暴发报告，但在过去的 4 年中，又报告了 7 起此类暴发。过去很可能有许多此类暴发被遗漏了，因为这种病原体属于生理性肠道菌群。然而，随着高度耐药（产碳青霉烯酶）菌株的出现，严格遵守感染控制指南比以往任何时候都更加重要。
