Department of Microbiology and Infectious Diseases, Sydney Local Health District Concord Hospital Human Research Ethics Committee, Hospital Rd, Concord, Sydney, NSW 2139, Australia.
Antimicrob Resist Infect Control. 2013 Dec 18;2(1):35. doi: 10.1186/2047-2994-2-35.
To describe the clinical epidemiology, environmental surveillance and infection control interventions undertaken in a six-year persistence of bla-IMP-4 metallo-beta-lactamase (MBL) producing Enterobacteriaceae within a separately confined hospital burns unit in a tertiary hospital in Sydney, Australia.
MBL positive clinical and environmental isolates were collected from the Burns Unit, from the first detection of isolates in September 2006 to August 2012. Unit-acquired clinical isolates were included, and patient outcomes analyzed amongst those who acquired clinically significant infections. Environmental isolates were analyzed with regard to relationship to clinical isolates, bacterial species, and persistence despite cleaning efforts.
Thirty clinical isolates detected from 23 patients were identified. Clinically significant infection developed in 7 (30%) patients - 2 bacteremias, 2 central venous catheter tip infections without bacteremia, and 3 wound infections. All patients survived at 30 days. Seventy-one environmental isolates were confirmed to be MBL-positive, with 85% sourced from shower facilities or equipment. MBL organisms persisted at these sites despite both usual hospital cleaning, and following targeted environmental disinfection interventions.
Clear association exists between environmental Burns Unit contamination by MBLs and subsequent patient colonization. Clinical infection occurred in a small proportion of patients colonized by MBLs, and with generally favorable outcomes. Its persistence in the Burns Unit environment, despite concerted infection control measures, pose concern for ongoing clinical transmission.
描述在澳大利亚悉尼一家三级医院的一个独立隔离的烧伤病房中，bla-IMP-4 金属β-内酰胺酶（MBL）产生肠杆菌科在六年内持续存在的临床流行病学、环境监测和感染控制干预措施。
从 2006 年 9 月首次发现分离株到 2012 年 8 月，从烧伤病房中收集了 MBL 阳性的临床和环境分离株。包括医院获得性临床分离株，并分析了获得临床显著感染的患者的结局。对环境分离株进行了分析，以了解其与临床分离株的关系、细菌种类以及尽管进行了清洁仍持续存在的情况。
从 23 名患者中发现了 30 株临床分离株。7 名（30%）患者发生了临床意义上的感染 - 2 例菌血症，2 例中心静脉导管尖端感染无菌血症，3 例伤口感染。所有患者在 30 天内存活。确认 71 株环境分离株为 MBL 阳性，其中 85%源自淋浴设施或设备。尽管进行了常规医院清洁和针对环境消毒干预措施，但 MBL 生物体仍在这些部位持续存在。
MBL 对烧伤病房环境的污染与随后的患者定植之间存在明显关联。在被 MBL 定植的患者中，临床感染的比例较小，且结局通常较好。尽管采取了集中的感染控制措施，但它在烧伤病房环境中的持续存在令人担忧会持续发生临床传播。
