Wenger P N, Brown J M, McNeil M M, Jarvis W R
Hospital Infections Program and Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Infect Dis. 1998 Nov;178(5):1539-43. doi: 10.1086/314450.
Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A. A case-control study comparing case-patients (n=5) with open heart surgery patients without subsequent sternotomy site infections (n=50) identified as risk factors diabetes (4/5 vs. 11/50, P<.02) and exposure to a particular anesthesiologist (anesthesiologist A; 4/5 vs. 9/50, P<.01). Four case-patients' isolates and a hand isolate of anesthesiologist A had an identical ribotype pattern (strain 1); the remaining case-patient's isolate and multiple isolates from anesthesiologist A's hands and home had a different ribotype pattern (strain 2). An intensified hand-washing regimen, barriers (gloves, gowns), and cleaning of anesthesiologist A's house were associated with termination of the outbreak. This is the first reported nosocomial N. farcinica outbreak to document the source and person-to-person transmission epidemiologically and molecularly.
尽管已有诺卡菌属豚鼠分枝杆菌手术部位感染暴发的报道（尽管很少见），但尚未确定其感染源。从1992年5月到1993年6月，A医院有5例患者在心脏直视手术后发生了诺卡菌属豚鼠分枝杆菌胸骨切开部位感染。一项病例对照研究将病例患者（n = 5）与无后续胸骨切开部位感染的心脏直视手术患者（n = 50）进行比较，确定糖尿病（4/5比11/50，P<0.02）和接触特定麻醉医生（麻醉医生A；4/5比9/50，P<0.01）为危险因素。4例病例患者的分离株和麻醉医生A手部的一个分离株具有相同的核糖体型模式（菌株1）；其余病例患者的分离株以及麻醉医生A手部和家中的多个分离株具有不同的核糖体型模式（菌株2）。强化洗手方案、屏障（手套、手术衣）以及对麻醉医生A的住所进行清洁与疫情的终止相关。这是首次报道的医院内诺卡菌属豚鼠分枝杆菌暴发，从流行病学和分子学角度记录了感染源和人际传播情况。
