Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China.
Department of Infection Control, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Int J Infect Dis. 2014 Jun;23:105-8. doi: 10.1016/j.ijid.2014.02.013. Epub 2014 Apr 18.
An outbreak of bacteremia caused by Pseudomonas spp (P. fulva and P. putida) was first identified in our hospital in the summer of 2010 and reoccurred in the following year. Based on the epidemiological data collected in these 2 years, we initiated an investigation on the source of the outbreak. The aim of this study was to report the results of the investigation, as well as the intervention strategies that resulted in successful control of the outbreak.
An infection control team was set up consisting of infectious disease specialists, microbiologists, infection control practitioners, and head nurses. The microbiology and medical records of case-patients with P. fulva or P. putida bloodstream infections were reviewed. Environmental samples and intravenous (IV) solutions from the wards and the pharmacy center were collected for culturing. The molecular characteristics of the bacterial isolates were studied by pulsed-field gel electrophoresis (PFGE). Strict infection control strategies were implemented.
A total of 20 case-patients from five inpatient wards were identified during three summer seasons from 2010 to 2012. Nineteen of them recovered with proper antibiotics. Unfortunately one died from complications of heart failure. A total of 19 isolates of P. fulva and four of P. putida were identified, of which 20 were from blood, two from environmental surface samples from the hospital pharmacy, and one from an in-use compounded solution from a case-patient in the cardiology ward. Molecular analysis revealed that the P. fulva isolated from the in-use compounded solution (5% glucose solution containing insulin, isosorbide dinitrate, and potassium magnesium aspartate) and the environmental samples had the same PFGE type as the clinical isolates.
The investigation identified that contaminated IV solution was the source of the P. fulva bacteremia, which prompted us to implement intensified control measures that resulted in successful control of the outbreak.
2010 年夏季，我院首次发现由铜绿假单胞菌（铜绿假单胞菌和恶臭假单胞菌）引起的菌血症暴发，并于次年再次发生。基于这 2 年收集的流行病学数据，我们对暴发的源头展开了调查。本研究旨在报告调查结果以及干预策略，这些策略成功控制了暴发。
成立了一个感染控制小组，成员包括传染病专家、微生物学家、感染控制从业者和护士长。回顾了铜绿假单胞菌或恶臭假单胞菌血流感染病例患者的微生物学和病历。采集病房和药房中心的环境样本和静脉（IV）溶液进行培养。通过脉冲场凝胶电泳（PFGE）研究细菌分离株的分子特征。实施严格的感染控制策略。
在 2010 年至 2012 年的三个夏季期间，从五个住院病房共发现 20 例病例患者。其中 19 例经适当抗生素治疗后康复。不幸的是，有 1 例因心力衰竭并发症死亡。共鉴定出 19 株铜绿假单胞菌和 4 株恶臭假单胞菌，其中 20 株来自血液，2 株来自医院药房环境表面样本，1 株来自心内科病房 1 例病例患者正在使用的复合溶液。分子分析显示，来自正在使用的复合溶液（含胰岛素、异山梨醇二硝酸酯和门冬氨酸钾镁的 5%葡萄糖溶液）和环境样本的铜绿假单胞菌与临床分离株具有相同的 PFGE 型。
调查确定受污染的 IV 溶液是铜绿假单胞菌菌血症的源头，这促使我们实施强化控制措施，成功控制了暴发。
