Alipour Nader, Karagoz Alper, Taner Abbas, Gaeini Nasrin, Alipour Nastaran, Zeytin Hassan, Yildiz Fatih, Durmaz Riza
Department of Microbiology & Biotechnology, Metu, Ankara, Turkey.
Department of Molecular Microbiology, Rafik Saydam Hifzi saha, Ankara, Turkey.
J Prev Med (Wilmington). 2017;2(2). doi: 10.21767/2572-5483.100014. Epub 2017 Oct 27.
Colistin-resistant () has been defined as pandrug-resistant (PDR) strain. Outbreaks of PDR especially in pulmonary tract infections due to contaminated bronchoscopes have rarely been reported. The emergence of pandrug-resistant strains in both CF (Cystic Fibrosis) and non-CF clinical isolates over recent years remains of a great concern. Hospital wards contaminated with PDR infection, must be shot down until their eradication. Health Authorities must be informed immediately and infection control strategies must be implemented.
To report such an outbreak and modify the infection control strategy in an academic hospital in Ankara Turkey.
From October to December 2013, PDR-Pseudomonas aerogionsa were identified from bronchial cultures of 15 patients who had undergone bronchoscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods.
A total of 70 specimens were obtained during the first surveillance operation. One Colistin-resistant was isolated from a bronchoscope. Although the disinfection protocols for bronchoscope were revised and implemented, seven additional bronchial cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until Ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the bronchoscope shared a common pattern with minor variance. XbaI restriction enzyme turned out better than SpeI in interpreting bacterial pulse types with BioNumerics 6.0. The most suitable cut off value for SpeI was above 80% Dice similarity while for XbaI above 95%Dice similarity with BioNumerics 6.0.
The outbreak of "Colistin" pan drug-resistant was caused by a contaminated bronchoscope and was terminated by the implementation of a revised disinfection protocol for bronchoscope.
耐黏菌素铜绿假单胞菌已被定义为泛耐药菌株。泛耐药铜绿假单胞菌的暴发，尤其是因支气管镜污染导致的肺部感染暴发，鲜有报道。近年来，囊性纤维化（CF）和非CF临床分离株中泛耐药菌株的出现一直备受关注。被泛耐药铜绿假单胞菌感染污染的医院病房，在根除之前必须关闭。必须立即通知卫生当局并实施感染控制策略。
报告土耳其安卡拉一家学术医院的此类暴发事件，并修改感染控制策略。
2013年10月至12月，从15例感染前接受过支气管镜检查的患者的支气管培养物中鉴定出泛耐药铜绿假单胞菌。从与这些操作相关的环境物体和医护人员中获取了三批监测培养物。采用脉冲场凝胶电泳（PFGE）进行细菌分型。通过纸片扩散法和E-test法评估抗菌药物敏感性。
在首次监测操作中总共获得了70份标本。从一台支气管镜中分离出一株耐黏菌素铜绿假单胞菌。尽管修订并实施了支气管镜消毒方案，但此后又发现了7例支气管病例。在随后的两次监测培养物中鉴定出了病原体，直到在消毒方案中增加环氧乙烷灭菌后才将其根除。PFGE显示，来自患者的所有15株分离菌和来自支气管镜的3株分离菌具有共同模式，仅有微小差异。在使用BioNumerics 6.0解释细菌脉冲类型时，XbaI限制酶比SpeI表现更好。对于SpeI，最合适的截断值是迪氏相似性高于80%，而对于XbaI，使用BioNumerics 6.0时迪氏相似性高于95%。
“黏菌素”泛耐药铜绿假单胞菌的暴发是由一台受污染的支气管镜引起的，通过实施修订后的支气管镜消毒方案得以终止。
