Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
Medical Department, Division of Hepatology and Gastroenterology, Charité - University Medicine Berlin, Berlin, Germany.
Antimicrob Resist Infect Control. 2015 Mar 25;4:8. doi: 10.1186/s13756-015-0049-4. eCollection 2015.
Carbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Here we report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated to duodenoscopy.
Between December 6, 2012 and January 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on 4 different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the bla OXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between 6 of the cases which were located on the same wards. The remaining 6 cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance.
Though the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here.
产碳青霉烯酶肠杆菌科（CPE）已成为全球医疗系统的主要问题。虽然来自欧洲医院的最初报告描述了 CPE 从流行国家的引入，但现在越来越多的报告描述了欧洲医院中 CPE 的爆发。在这里，我们报告了德国一家大学医院发生的耐碳青霉烯肺炎克雷伯菌（CRKP）爆发，该爆发部分与十二指肠镜检查有关。
2012 年 12 月 6 日至 2013 年 1 月 10 日，从 4 个不同病房的 12 名患者中培养出耐碳青霉烯肺炎克雷伯菌（CRKP）。多重 PCR 扩增碳青霉烯酶基因显示 bla OXA-48 基因的存在。分子分型证实了所有 12 个分离株的同一性。回顾 CRKP 病例的病历记录显示，其中 6 例病例位于同一病房，存在空间关系。其余 6 例均与使用同一十二指肠镜进行的内镜逆行胰胆管造影（ERCP）有关。在将内窥镜发送给制造商进行维护后，疫情结束。
尽管爆发菌株也传播到未接受 ERCP 的患者和环境来源或医务人员也为爆发做出了贡献，但定植患者的肠道是 CPE 的主要来源。因此，准确严格地处理内镜仪器非常重要，对于像在描述的爆发中涉及的更复杂的仪器（TJF Q180V 系列）更是如此。
