Allen J I, Allen M O, Olson M M, Gerding D N, Shanholtzer C J, Meier P B, Vennes J A, Silvis S E
Gastroenterology. 1987 Mar;92(3):759-63. doi: 10.1016/0016-5085(87)90029-1.
Pseudomonas aeruginosa was present in bile cultures from 10 patients who had undergone previous endoscopic retrograde cholangiopancreatography in 1984. After environmental cultures and review of instrument disinfection, we traced the infections to a single endoscope contaminated with P. aeruginosa, serotype 10. Although the instrument had been cleaned repeatedly with an automatic endoscope cleaning machine, P. aeruginosa survived on residual moisture left in the channels of the endoscope. Contamination ended only after we began to manually suction alcohol through the endoscope before air drying. In 5 of 10 patients, P. aeruginosa caused clinical infections including gangrenous cholecystitis, abscesses, and death. We could identify no factor that distinguished symptomatic from asymptomatic patients. In asymptomatic patients, P. aeruginosa was recovered from gallbladder bile up to 2 mo after endoscopic retrograde cholangiopancreatography. As this P. aeruginosa epidemic was discovered retrospectively because we monitor bile cultures, we advocate this practice as part of endoscopic retrograde cholangiopancreatography procedures.
1984年，10例曾接受过内镜逆行胰胆管造影术的患者胆汁培养物中发现了铜绿假单胞菌。经过环境培养和器械消毒情况检查，我们将感染追溯至一台被10型铜绿假单胞菌污染的内镜。尽管该器械已用自动内镜清洗机反复清洗，但铜绿假单胞菌仍在内镜通道残留的水分中存活。直到我们开始在空气干燥前通过内镜手动抽吸酒精后，污染才得以终止。10例患者中有5例发生了由铜绿假单胞菌引起的临床感染，包括坏疽性胆囊炎、脓肿，甚至死亡。我们未能找出区分有症状和无症状患者的因素。在无症状患者中，内镜逆行胰胆管造影术后长达2个月仍可从胆囊胆汁中分离出铜绿假单胞菌。由于我们监测胆汁培养物，这例铜绿假单胞菌感染流行是通过回顾性研究发现的，我们提倡将这种做法作为内镜逆行胰胆管造影术操作的一部分。
