Hamill R J, Houston E D, Georghiou P R, Wright C E, Koza M A, Cadle R M, Goepfert P A, Lewis D A, Zenon G J, Clarridge J E
Section of Infectious Diseases (111G), Veterans Affairs Medical Center, Houston, TX 77030, USA.
Ann Intern Med. 1995 May 15;122(10):762-6. doi: 10.7326/0003-4819-122-10-199505150-00005.
To investigate an outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection in mechanically ventilated patients.
A retrospective case-control and bacteriologic study.
Veterans Affairs medical center.
42 mechanically ventilated patients who developed respiratory tract colonization or infection with B. cepacia and 135 ventilator-dependent controls who were not colonized and did not develop infections.
Clinical and demographic data; benzalkonium chloride concentrations and pH levels in albuterol sulfate solutions; repetitive-element polymerase chain reaction (PCR)-mediated molecular fingerprinting on eight patient isolates and three environmental B. cepacia isolates that were available for study.
42 patients had B. cepacia respiratory tract colonization or infection. Observation of intensive care unit and respiratory care personnel showed faulty infection control procedures (for example, the same multiple-dose bottle of albuterol was used for many mechanically ventilated patients). More case patients (39 [92.9%]) than controls (95 [70.4%]; P = 0.006) received nebulized albuterol, and case patients (67.5 treatments) received more treatments than controls (18 treatments; P < 0.001). In-use albuterol solutions had pH values that were unstable, and benzalkonium chloride concentrations declined over time to levels capable of supporting bacterial growth. Medication nebulizers and in-use bottles of albuterol harbored B. cepacia. Molecular fingerprints of patient isolates and environmental B. cepacia isolates were identical using repetitive-element PCR. No further isolates of B. cepacia were identified after institution of appropriate infection control procedures.
Multiple-dose medications and reliance on benzalkonium chloride as a medication preservative provide a mechanism for nosocomial spread of microorganisms, particularly if infection control procedures are not carefully followed. Repetitive-element PCR is a useful fingerprinting technique for molecular epidemiologic studies of B. cepacia.
调查在机械通气患者中发生的洋葱伯克霍尔德菌（以前称为铜绿假单胞菌）呼吸道定植和感染的暴发情况。
一项回顾性病例对照和细菌学研究。
退伍军人事务医疗中心。
42例发生呼吸道洋葱伯克霍尔德菌定植或感染的机械通气患者，以及135例未发生定植且未感染的依赖呼吸机的对照患者。
临床和人口统计学数据；硫酸沙丁胺醇溶液中的苯扎氯铵浓度和pH值；对8株患者分离株和3株可供研究的环境洋葱伯克霍尔德菌分离株进行重复元件聚合酶链反应（PCR）介导的分子指纹分析。
42例患者发生了呼吸道洋葱伯克霍尔德菌定植或感染。对重症监护病房和呼吸护理人员的观察发现感染控制程序存在缺陷（例如，同一多剂量瓶的沙丁胺醇被用于许多机械通气患者）。接受雾化沙丁胺醇治疗的病例患者（39例[92.9%]）多于对照患者（95例[70.4%]；P = 0.006），且病例患者接受的治疗次数（67.5次）多于对照患者（18次；P < 0.001）。使用中的沙丁胺醇溶液pH值不稳定，苯扎氯铵浓度随时间下降至能够支持细菌生长的水平。药物雾化器和使用中的沙丁胺醇瓶中存在洋葱伯克霍尔德菌。使用重复元件PCR对患者分离株和环境洋葱伯克霍尔德菌分离株进行分子指纹分析，结果显示二者相同。采取适当的感染控制措施后，未再发现洋葱伯克霍尔德菌分离株。
多剂量药物以及依赖苯扎氯铵作为药物防腐剂为微生物的医院内传播提供了一种机制，尤其是在未严格遵循感染控制程序的情况下。重复元件PCR是用于洋葱伯克霍尔德菌分子流行病学研究的一种有用的指纹分析技术。
