Mainz Jochen G, Gerber Andrea, Lorenz Michael, Michl Ruth, Hentschel Julia, Nader Anika, Beck James F, Pletz Mathias W, Mueller Andreas H
Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany.
Case Rep Infect Dis. 2015;2015:438517. doi: 10.1155/2015/438517. Epub 2015 Mar 18.
Introduction. P. aeruginosa is the primary cause for pulmonary destruction and premature death in cystic fibrosis (CF). Therefore, prevention of airway colonization with the pathogen, ubiquitously present in water, is essential. Infection of CF patients with P. aeruginosa after dentist treatment was proven and dental unit waterlines were identified as source, suggesting prophylactic measures. For their almost regular sinonasal involvement, CF patients often require otorhinolaryngological (ORL) attendance. Despite some fields around ORL-procedures with comparable risk for acquisition of P. aeruginosa, such CF cases have not yet been reported. We present four CF patients, who primarily acquired P. aeruginosa around ORL surgery, and one around dentist treatment. Additionally, we discuss risks and preventive strategies for CF patients undergoing ORL-treatment. Perils include contact to pathogen-carriers in waiting rooms, instrumentation, suction, drilling, and flushing fluid, when droplets containing pathogens can be nebulized. Postsurgery mucosal damage and debridement impair sinonasal mucociliary clearance, facilitating pathogen proliferation and infestation. Therefore, sinonasal surgery and dentist treatment of CF patients without chronic P. aeruginosa colonization must be linked to repeated microbiological assessment. Further studies must elaborate whether all CF patients undergoing ORL-surgery require antipseudomonal prophylaxis, including nasal lavages containing antibiotics. Altogether, this underestimated risk requires structured prevention protocols.
引言。铜绿假单胞菌是囊性纤维化（CF）患者肺部破坏和过早死亡的主要原因。因此，预防被这种普遍存在于水中的病原体定植于气道至关重要。已证实CF患者在牙科治疗后会感染铜绿假单胞菌，且牙科设备水线被确定为感染源，这提示了预防措施。由于CF患者几乎经常累及鼻窦，他们常需要耳鼻喉科（ORL）就诊。尽管在一些与获取铜绿假单胞菌风险相当的ORL手术领域，但尚未有此类CF病例的报道。我们报告了4例主要在ORL手术期间感染铜绿假单胞菌的CF患者，以及1例在牙科治疗期间感染的患者。此外，我们讨论了CF患者接受ORL治疗的风险和预防策略。风险包括在候诊室接触病原体携带者、器械操作、抽吸、钻孔以及冲洗液，此时含有病原体的飞沫可能会形成气溶胶。术后黏膜损伤和清创会损害鼻窦黏液纤毛清除功能，从而促进病原体增殖和感染。因此，对于无慢性铜绿假单胞菌定植的CF患者进行鼻窦手术和牙科治疗时，必须与反复的微生物学评估相结合。进一步的研究必须阐明是否所有接受ORL手术的CF患者都需要进行抗假单胞菌预防，包括含抗生素的鼻腔灌洗。总之，这种被低估的风险需要有结构化的预防方案。
