Semin-Pelletier B, Cazet L, Bourigault C, Juvin M E, Boutoille D, Raffi F, Hourmant M, Blancho G, Agard C, Connault J, Corvec S, Caillon J, Batard E, Lepelletier D
Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France.
Infectious Diseases Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France.
J Hosp Infect. 2015 Apr;89(4):248-53. doi: 10.1016/j.jhin.2014.11.018. Epub 2015 Jan 5.
A large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae at Nantes University Hospital was investigated. The index case had no history of travel or hospitalization abroad and had been hospitalized in the internal medicine department for more than one month when the epidemic strain was isolated from a urine sample in June 2013. Seventy-two secondary cases were detected by weekly screening for gastrointestinal colonization during the two phases of the outbreak from June to October 2013 (33 cases) and from November 2013 to August 2014 (39 cases). Spread of the epidemic strain was attributed to the proximity of, and staff movement between, the infectious diseases (32 cases) and the internal medicine (26 cases) departments; 14 secondary cases were also observed in the renal transplant department following the transfer of an exposed patient from the infectious diseases department. Most of the patients (90%) were colonized and no death was linked to the epidemic strain. More than 3000 contact patients were reviewed and 6000 rectal swabs were performed. Initial control measures failed to control the outbreak owing to the late detection of the index case. The late implementation of three successive cohort units, the large number of transfers between wards, and the frequent readmission of cases contributed to the incomplete success of control measures.
对南特大学医院发生的一起由产OXA - 48碳青霉烯酶肺炎克雷伯菌引起的大规模疫情进行了调查。首例病例无国外旅行或住院史，2013年6月从其尿液样本中分离出流行菌株时，该病例已在内科住院一个多月。在2013年6月至10月（33例）和2013年11月至2014年8月（39例）这两个疫情阶段，通过每周对胃肠道定植情况进行筛查，共检测到72例二代病例。流行菌株的传播归因于传染病科（32例）和内科（26例）相邻以及工作人员在两科室之间流动；一名暴露患者从传染病科转入肾移植科后，该科室也观察到14例二代病例。大多数患者（90%）被定植，且无死亡与流行菌株相关。对3000多名接触患者进行了检查，并采集了6000份直肠拭子样本。由于首例病例发现较晚，最初的控制措施未能控制住疫情。三个连续队列单元实施较晚、病房之间大量的患者转运以及病例频繁再次入院，导致控制措施未完全成功。
