Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea; Infection Control Office, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
J Hosp Infect. 2018 Mar;98(3):295-299. doi: 10.1016/j.jhin.2017.09.012. Epub 2017 Sep 19.
Burkholderia cepacia is intrinsically resistant to certain antiseptics. The authors noted a sudden increase in the frequency of isolation of B. cepacia from blood cultures in a neonatal intensive care unit (NICU) of a university-affiliated hospital.
To identify the source and intervene in the ongoing infections.
The cases were defined as patients with positive blood cultures for B. cepacia in an NICU between November 2014 and January 2015. Medical records were reviewed and NICU healthcare workers were interviewed. Samples of suspected antiseptics, blood culture bottles, cotton balls, gauze and a needle used in the NICU were analysed microbiologically.
During the outbreak period, B. cepacia was identified in 25 blood cultures obtained from 21 patients. The clinical features of the patients were suggestive of pseudobacteraemia. Regarding environmental samples, B. cepacia was cultured from 0.5% chlorhexidine gluconate (CHG) solution products that had been used as a skin antiseptic during blood drawing in the NICU. The clinical B. cepacia isolate and two strains obtained from 0.5% CHG exhibited identical pulsed-field gel electrophoresis patterns. After the CHG products were withdrawn, the outbreak was resolved.
The pseudobacteraemia cases were caused by contaminated 0.5% CHG produced by a single manufacturer. Stricter government regulation is needed to prevent contamination of disinfectants during manufacturing. In addition, microbial contamination of antiseptics and disinfectants should be suspected when a B. cepacia outbreak occurs in hospitalized patients.
洋葱伯克霍尔德菌对某些防腐剂具有固有抗性。作者注意到，在一家大学附属医院的新生儿重症监护病房（NICU）中，洋葱伯克霍尔德菌从血液培养物中分离的频率突然增加。
确定来源并干预正在进行的感染。
将 2014 年 11 月至 2015 年 1 月期间 NICU 中血液培养物呈阳性的 B. cepacia 患者定义为病例。回顾病历并采访 NICU 医护人员。对疑似防腐剂、血培养瓶、棉球、纱布和 NICU 中使用的针进行微生物分析。
在暴发期间，从 21 名患者的 25 份血液培养物中鉴定出 25 株 B. cepacia。患者的临床特征提示假性菌血症。关于环境样本，从 NICU 采血时用作皮肤消毒剂的 0.5%葡萄糖酸氯己定（CHG）溶液产品中培养出 B. cepacia。临床分离的 B. cepacia 菌株和从 0.5% CHG 获得的两株菌株表现出相同的脉冲场凝胶电泳模式。停用 CHG 产品后，暴发得到解决。
假性菌血症病例是由单一制造商生产的受污染的 0.5% CHG 引起的。需要更严格的政府监管，以防止消毒剂在生产过程中受到污染。此外，当住院患者发生洋葱伯克霍尔德菌暴发时，应怀疑防腐剂和消毒剂的微生物污染。
