See Isaac, Nguyen Duc B, Chatterjee Somu, Shwe Thein, Scott Melissa, Ibrahim Sherif, Moulton-Meissner Heather, McNulty Steven, Noble-Wang Judith, Price Cindy, Schramm Kim, Bixler Danae, Guh Alice Y
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
Infect Control Hosp Epidemiol. 2014 Mar;35(3):300-6. doi: 10.1086/675282.
To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility.
Epidemiologic investigation of the outbreak with a case-control study.
A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.
Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.
Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.
确定一家门诊肿瘤治疗机构中龟分枝杆菌属血流感染暴发的源头并识别控制措施。
采用病例对照研究对该暴发进行流行病学调查。
病例定义为2011年1月至2012年6月期间在肿瘤门诊患者中，从血液或导管尖端培养物中分离出龟分枝杆菌属的感染。查阅了当地医院的实验室记录和患者病历。在门诊患者中开展病例对照研究，以识别龟分枝杆菌属血流感染的危险因素。对门诊工作人员进行了访谈，并评估了感染控制措施。
共识别出15例龟分枝杆菌（龟分枝杆菌肺炎亚种或酪黄龟分枝杆菌）血流感染病例，所有病例均为患有基础恶性肿瘤且留置中心静脉导管的患者。病例患者的中位年龄为68岁；47%为男性。唯一显著的感染危险因素是在2011年9月至10月期间从门诊接受了盐水冲管（P = 0.03），当时门诊一直从一个共用的盐水袋中配制盐水冲管液。在该门诊识别出的其他感染控制缺陷包括中心静脉置管操作及化疗配制流程欠佳。
尽管识别出了多个感染控制失误，但此次暴发很可能是由门诊盐水冲管注射器配制不当所致。此次暴发表明，肿瘤患者的血流感染可能源于不当的感染控制措施，并凸显了在门诊肿瘤治疗环境中加强对感染控制的关注和监督的迫切需求。
