Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France; Département d'anesthésie et de réanimation chirurgicale, 75018, Centre Hospitalier de Bichat, Paris, France.
Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France.
J Hosp Infect. 2018 Nov;100(3):e105-e114. doi: 10.1016/j.jhin.2018.05.016. Epub 2018 May 29.
To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD).
The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim.
A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis.
A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens.
Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
评估重症监护病房（ICU）意外搬迁对耐亚胺培南铜绿假单胞菌（PA-OprD）定植/感染风险的影响。
主要目的是比较 ICU 意外搬迁前后 PA-OprD 分离的铜绿假单胞菌样本的比例。次要目的是评估自来水作为 PA-OprD 定植/感染患者污染途径的作用。
2013 年 10 月至 2015 年 10 月进行了一项单中心、观察性、前后对照研究。ICU 于 2014 年 10 月底搬迁。所有在 ICU 住院≥48 小时的患者分离的铜绿假单胞菌阳性样本均纳入研究。ICU 每三个月采集一次自来水样本。采用脉冲场凝胶电泳对患者和自来水中分离的 PA-OprD 菌株进行基因分型。
共分析了 139 份铜绿假单胞菌临床标本和 19 份自来水样本。ICU 搬迁后，PA-OprD 菌株的比例从 31%显著下降至 7.7%（P=0.004）。所有 PA-OprD 临床标本均具有独特的基因型。令人惊讶的是，两段时间自来水中均定植有单一的 PA-OprD 菌株，但该单一克隆从未从临床标本中分离出来。
ICU 搬迁与耐亚胺培南铜绿假单胞菌菌株的显著减少相关。从患者中分离的 PA-OprD 菌株的多克隆特征以及自来水中无患者污染表明环境对铜绿假单胞菌内源性定植/感染的影响的复杂性。
