Burdge D R, Nakielna E M, Noble M A
Division of Infectious Disease, University Hospital, Vancouver, British Columbia, Canada.
Infect Control Hosp Epidemiol. 1993 Mar;14(3):127-30. doi: 10.1086/646697.
To examine factors associated with nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.
A retrospective case-control study of 5 patients with nosocomial acquisition of P cepacia versus 20 matched controls who failed to develop P cepacia infection. Selective handwashing, air sampling, and respiratory equipment sampling also were performed.
A university hospital providing tertiary care to 95 adult cystic fibrosis patients.
All patients are adults with known cystic fibrosis. Case definition required multiple negative sputum cultures for P cepacia prior to and during admission, with a positive sputum culture prior to discharge. Controls had negative sputum cultures for P cepacia prior to and throughout hospitalization. Controls were matched for age, gender, disease severity, and frequency of hospitalizations.
Factors associated with increased risk of nosocomial acquisition of P cepacia included receiving humidifier or nebulized treatments (60% versus 5%, p = .016, odds ratio = 28.5, 95% confidence interval = 1.93 to 420.58). Factors without significance included ward, room, teaching versus nonteaching status, use of steroids, sharing a hospital room with another cystic fibrosis patient, antibiotic use, presence of portocath in situ, or socializing with another individual with cystic fibrosis known to be P cepacia-positive. Air sampling studies failed to demonstrate aerosolization of P cepacia by coughing cystic fibrosis patients over a 1-hour sampling time. Handwashing studies failed to demonstrate P cepacia on hands of cystic fibrosis patients, nurses, or physiotherapists (before or after physiotherapy). Reservoirs from nebulizers consistently grew P cepacia following therapy.
Respiratory equipment may be an important source of nosocomial acquisition of P cepacia in adult cystic fibrosis patients.
研究成年囊性纤维化患者医院获得性洋葱伯克霍尔德菌感染的相关因素。
一项回顾性病例对照研究，选取5例医院获得性洋葱伯克霍尔德菌感染患者，与20例未发生该感染的匹配对照进行比较。同时进行选择性洗手、空气采样和呼吸设备采样。
一家为95例成年囊性纤维化患者提供三级护理的大学医院。
所有患者均为已知患有囊性纤维化的成年人。病例定义要求入院前及住院期间多次痰培养洋葱伯克霍尔德菌阴性，出院前痰培养阳性。对照在住院前及住院期间痰培养洋葱伯克霍尔德菌均为阴性。对照按年龄、性别、疾病严重程度和住院频率进行匹配。
与医院获得性洋葱伯克霍尔德菌感染风险增加相关的因素包括接受加湿器或雾化治疗（60% 对5%，p = 0.016，优势比 = 28.5，95% 置信区间 = 1.93至420.58）。无显著意义的因素包括病房、房间、教学与非教学状态、使用类固醇、与另一位囊性纤维化患者共用病房、使用抗生素、留置静脉导管、或与另一位已知洋葱伯克霍尔德菌阳性的囊性纤维化患者交往。空气采样研究未能证明囊性纤维化患者咳嗽1小时期间有洋葱伯克霍尔德菌气溶胶形成。洗手研究未能在囊性纤维化患者、护士或物理治疗师手上发现洋葱伯克霍尔德菌（物理治疗前后）。雾化器容器在治疗后持续培养出洋葱伯克霍尔德菌。
呼吸设备可能是成年囊性纤维化患者医院获得性洋葱伯克霍尔德菌感染的重要来源。
