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与超声传播凝胶相关的长时间术后爆发性感染马萨利军团菌

Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel.

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Clin Microbiol Infect. 2016 Apr;22(4):382.e1-382.e11. doi: 10.1016/j.cmi.2015.11.021. Epub 2016 Jan 18.

Abstract

Postprocedural infections by Mycobacterium abscessus complex are increasing worldwide, and the source and route of transmission are infrequently identified. Here the extension of a previous clustering of paediatric patients with surgical site infections due to a single strain of the subspecies M. massiliense is reported. The investigation was conducted at a 2200-bed teaching hospital in Taiwan and included microbial surveillance of the environment (water, air, equipment and supplies) and a case-control study. We performed molecular identification and typing of the isolates by a trilocus sequencing scheme, confirmed by multilocus sequencing typing and pulsed-field gel electrophoresis. We investigated 40 patients who developed postprocedure soft tissue or bloodstream infections by M. massiliense (TPE101) during a 3-year period. Thirty-eight patients were identified at hospital A, and one newborn and her mother were identified at hospital B (185 km from hospital A). A case-control study identified the association of invasive procedures (adjusted odds ratio, 9.13) and ultrasonography (adjusted odds ratio, 2.97) (both p <0.05) with acquiring the outbreak strain. Isolates from the cases and unopened bottles of ultrasound transmission gel were all of strain ST48 and indistinguishable or closely related by pulsed-field gel electrophoresis. After replacement of contaminated gel, no new cases were detected during 18 months' follow-up. This investigation identified the use of contaminated gel as the common source causing an outbreak on a larger scale than had been recognized. Our findings halted production by the manufacturer and prompted revision of hospital guidelines.

摘要

分枝杆菌复合群术后感染在全球范围内日益增多,而其传染源和传播途径却很少被确定。在此,报告了先前一次因单一亚种马萨诸塞分枝杆菌(M. massiliense)菌株引起的儿科手术部位感染患者聚集的扩展。该调查在台湾一家拥有 2200 张床位的教学医院进行,包括对环境(水、空气、设备和用品)进行微生物监测和病例对照研究。我们通过三基因座测序方案对分离株进行了分子鉴定和分型,并用多位点测序分型和脉冲场凝胶电泳进行了确认。我们调查了在 3 年期间发生术后软组织或血流分枝杆菌(TPE101)感染的 40 名患者。38 名患者在医院 A 被确诊,一名新生儿及其母亲在距离医院 A 185 公里的医院 B 被确诊。病例对照研究确定了侵入性操作(调整后的优势比,9.13)和超声检查(调整后的优势比,2.97)(均 P <0.05)与获得暴发菌株之间的关联。病例和未开封的超声传播凝胶瓶中的分离株均为 ST48 菌株,通过脉冲场凝胶电泳无法区分或密切相关。更换污染凝胶后,在 18 个月的随访中未发现新病例。该调查确定了使用污染凝胶作为导致暴发的共同来源,其规模比以前认识到的要大。我们的研究结果停止了制造商的生产,并促使修订了医院指南。

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