Kaslow R A, Lindsey J O, Bisno A L, Price A
Am J Epidemiol. 1976 Sep;104(3):278-86. doi: 10.1093/oxfordjournals.aje.a112301.
Over 22-1/2 months an epidemic of at least 127 cases of nosocomial infection developed from a strain of Proteus rettgeri resistant to all antibiotics commonly tested in hospital laboratories. Although there were at least four cases of septicemia and one related death, the majority of cases consisted of asymptomatic bacteriuria or clinically mild urinary tract infection. Indwelling urinary tract devices and antibiotic therapy were important predisposing factors. Data supported an association between increasing use of gentamicin and increasing rates of resistant infection. No common source was found, and contact spread appeared more likely. Control measures included efforts to reduce unnecessary exposure to the incriminated risk factors and to improve asepsis in the management of catheterized patients. An additional 36 cases and one related death were identified in the 7-1/2 months following the investigation and institution of control measures. Nosocomial infection with extremely resistant organisms may pose a serious hazard wherever indwelling urinary tract devices and antibiotics are used together intensively.
在22个半月的时间里，由一株对医院实验室常规检测的所有抗生素均耐药的雷氏变形杆菌引发了一场至少127例医院感染的疫情。尽管至少有4例败血症病例且有1例相关死亡，但大多数病例为无症状菌尿或临床症状轻微的尿路感染。留置尿路装置和抗生素治疗是重要的易感因素。数据支持庆大霉素使用增加与耐药感染率上升之间存在关联。未发现共同来源，接触传播似乎更有可能。控制措施包括努力减少对相关危险因素的不必要暴露，并改善导尿患者管理中的无菌操作。在调查和实施控制措施后的7个半月里，又发现了36例病例和1例相关死亡。在留置尿路装置和抗生素同时大量使用的任何地方，由具有极强耐药性的生物体引起的医院感染都可能构成严重危害。
