Bennett S N, McNeil M M, Bland L A, Arduino M J, Villarino M E, Perrotta D M, Burwen D R, Welbel S F, Pegues D A, Stroud L
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
N Engl J Med. 1995 Jul 20;333(3):147-54. doi: 10.1056/NEJM199507203330303.
Between June 1990 and February 1993, the Centers for Disease Control and Prevention conducted investigations at seven hospitals because of unusual outbreaks of bloodstream infections, surgical-site infections, and acute febrile episodes after surgical procedures.
We conducted case-control or cohort studies, or both, to identify risk factors. A case patient was defined as any patient who had an organism-specific infection or acute febrile episode after a surgical procedure during the study period in that hospital. The investigations also included reviews of procedures, cultures, and microbiologic studies of infecting, contaminating, and colonizing strains.
Sixty-two case patients were identified, 49 (79 percent) of whom underwent surgery during an epidemic period. Postoperative complications were more frequent during the epidemic period than before it. Only exposure to propofol, a lipid-based anesthetic agent, was significantly associated with the postoperative complications at all seven hospitals. In six of the outbreaks, an etiologic agent (Staphylococcus aureus, Candida albicans, Moraxella osloensis, Enterobacter agglomerans, or Serratia marcescens) was identified, and the same strains were isolated from the case patients. Although cultures of unopened containers of propofol were negative, at two hospitals cultures of propofol from syringes currently in use were positive. At one hospital, the recovered organism was identical to the organism isolated from the case patients. Interviews with and observation of anesthesiology personnel documented a wide variety of lapses in aseptic techniques.
With the increasing use of lipid-based medications, which support rapid bacterial growth at room temperature, strict aseptic techniques are essential during the handling of these agents to prevent extrinsic contamination and dangerous infectious complications.
1990年6月至1993年2月期间，美国疾病控制与预防中心对七家医院进行了调查，原因是出现了不寻常的血流感染、手术部位感染以及手术后急性发热事件。
我们进行了病例对照研究或队列研究，或两者兼而有之，以确定危险因素。病例患者定义为在该医院研究期间手术后发生特定病原体感染或急性发热事件的任何患者。调查还包括对感染、污染和定植菌株的操作、培养及微生物学研究的审查。
共确定了62例病例患者，其中49例（79%）在流行期间接受了手术。流行期间术后并发症比之前更频繁。在所有七家医院中，仅接触丙泊酚（一种脂类麻醉剂）与术后并发症显著相关。在六次疫情爆发中，确定了病原体（金黄色葡萄球菌、白色念珠菌、奥斯陆莫拉菌、成团肠杆菌或粘质沙雷菌），并且从病例患者中分离出了相同的菌株。尽管未开封的丙泊酚容器培养结果为阴性，但在两家医院，正在使用的注射器中的丙泊酚培养结果为阳性。在一家医院，分离出的病原体与从病例患者中分离出的病原体相同。对麻醉人员的访谈和观察记录了无菌技术方面的各种失误。
随着脂类药物使用的增加，这类药物在室温下支持细菌快速生长，因此在处理这些药物时严格的无菌技术对于防止外部污染和危险的感染并发症至关重要。
