Ida Yoko, Ohnishi Hiroaki, Araki Kouji, Saito Ryoichi, Kawai Shin, Watanabe Takashi
Yoko Ida, Hiroaki Ohnishi, Kouji Araki, Takashi Watanabe, Clinical Laboratory, Kyorin University Hospital, Tokyo 181-8611, Japan.
World J Methodol. 2016 Mar 26;6(1):126-32. doi: 10.5662/wjm.v6.i1.126.
To seek the cause of Burkholderia cepacia complex (Bcc) infection outbreak and evaluate the efficacy of new methods for nebulizer maintenance.
We investigated the annual number of Bcc isolates recovered from clinical samples in our hospital between 1999 and 2013. Swab samples were randomly collected for bacterial culture before patient use from 10 each of the two machine types in August 2001; these included 20 samples from each of the following: Drain tubes, operating water chambers, oscillators, and nebulizing chambers. In addition, 10 samples each of nebulizer solutions before and after use were cultured. For environmental investigation, 10 samples were collected from sinks in the nurse stations of the wards where patients positive for Bcc were hospitalized. Numbers of Bcc isolates were compared before and after introduction of new methods for nebulizer maintenance in October 2001. In addition, randomly amplified polymorphic DNA (RAPD) assay was applied to find the genetic divergence of the Bcc isolates obtained from clinical samples and nebulizers.
From January 1999 to December 2013, a total of 487 Bcc isolates were obtained from clinical specimens from 181 patients. Notably, 322 (66.1%) Bcc isolates were obtained from clinical specimens from 1999 to 2001, including 244 (115 patients) from sputum and 34 (11 patients) from blood. During this period, 14 isolates were obtained from nebulizer components. Among these, six were derived from nebulizer drain tubes, five from operating water chambers, and one from the oscillator before patient use, and two from nebulizer solutions after patient use. When Bcc was isolated from the nebulizer solution after patient use, Bcc was simultaneously detected in other parts of the nebulizer. Bcc was not isolated from any nebulizer solution before use. RAPD assays revealed similar DNA profiles in isolates obtained from patients and nebulizers. Investigation revealed damaged diaphragms in many nebulizers. The new maintenance methods for nebulizers, including restriction of the usage period, thorough disinfection, and routine check for diaphragm breakage, remarkably reduced Bcc isolation (165 isolates from patients in 12 years and 0 isolate from nebulizers in periodical sampling). In particular, Bcc has been isolated from blood from only one patient since the new methods were introduced.
Appropriate maintenance of ultrasonic nebulizers is crucial for preventing Bcc contamination of nebulizers and subsequent respiratory tract and blood infections.
探寻洋葱伯克霍尔德菌复合体（Bcc）感染暴发的原因，并评估雾化器维护新方法的效果。
我们调查了1999年至2013年期间我院从临床样本中分离出的Bcc菌株的年度数量。2001年8月，从两种机型各10台雾化器中在患者使用前随机采集拭子样本进行细菌培养；这些样本包括以下各项各20份：引流管、操作水腔、振荡器和雾化腔。此外，对10份雾化器溶液在使用前后分别进行培养。对于环境调查，从Bcc检测呈阳性的患者所住病房的护士站水槽中采集10份样本。比较了2001年10月引入雾化器维护新方法前后Bcc菌株的数量。此外，应用随机扩增多态性DNA（RAPD）分析来查找从临床样本和雾化器中获得的Bcc菌株的基因差异。
1999年1月至2013年12月，共从181例患者的临床标本中分离出487株Bcc菌株。值得注意的是，1999年至2001年期间从临床标本中分离出322株（66.1%）Bcc菌株，其中244株（来自115例患者）来自痰液，34株（来自11例患者）来自血液。在此期间，从雾化器部件中分离出14株菌株。其中，6株来自雾化器引流管，5株来自操作水腔，1株来自患者使用前的振荡器，2株来自患者使用后的雾化器溶液。当在患者使用后的雾化器溶液中分离出Bcc时，在雾化器的其他部位也同时检测到Bcc。在使用前的任何雾化器溶液中均未分离出Bcc。RAPD分析显示从患者和雾化器中获得的菌株具有相似的DNA图谱。调查发现许多雾化器的隔膜有损坏。雾化器的新维护方法，包括限制使用期限、彻底消毒以及定期检查隔膜破损情况，显著减少了Bcc的分离（12年中从患者中分离出165株，定期采样中从雾化器中未分离出菌株）。特别是，自引入新方法以来，仅从1例患者的血液中分离出Bcc。
适当维护超声雾化器对于预防Bcc污染雾化器以及随后的呼吸道和血液感染至关重要。
