德国一起因瓶装水被污染而导致的ICU铜绿假单胞菌爆发感染
ORIGINAL ARTICLEAn outbreak of hospital-acquired Pseudomonas aeruginosa infection caused by contaminated bottled water in intensive care units
德国一起因瓶装水被污染而导致的ICU铜绿假单胞菌爆发感染
T. Eckmanns11Robert Koch Institute, M. Oppert22Department of Nephrology, Medical Intensive Care, M. Martin33Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Humboldt University, Berlin, Germany, R. Amorosa33Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Humboldt University, Berlin, Germany, I. Zuschneid11Robert Koch Institute, U. Frei22Department of Nephrology, Medical Intensive Care, H. Rüden33Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Humboldt University, Berlin, Germany and K. Weist33Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Humboldt University, Berlin, Germany1Robert Koch Institute, 2Department of Nephrology, Medical Intensive Care and 3Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
Corresponding author and reprint requests: T. Eckmanns, Robert Koch Institute, Seestr. 10, 13393 Berlin, Germany
E-mail: eckmannst@rki.de
Abstract
This study describes an outbreak of Pseudomonas aeruginosa infections caused by contaminated bottled still water (BSW) in six intensive care units (ICUs) of a German university hospital. Clinical and environmental samples from these units were cultured and genotyped by amplified fragment-length polymorphism and pulsed-field gel electrophoresis analysis. Microbiological results were reviewed on a weekly basis to determine the number of P. aeruginosa infections and colonisations of ICU patients. Clinical specimens from 19 ICU patients—15 infections and four colonisations—yielded the same strain of P. aeruginosa. Furthermore, four of 103 environmental samples also yielded P. aeruginosa. However, only a P. aeruginosa strain isolated from unopened BSW was genetically identical to the P. aeruginosa strain isolated from the patients. In the 42-week period before the outbreak, the mean weekly number of new ICU patients infected or colonised with P. aeruginosa was 46.9 (95% CI 40.7–53.1)/1000 bed-days. During the 6-week period of the outbreak, the weekly number of new patients with P. aeruginosa was 88.9 (95% CI 54.3–122.2)/1000 bed-days. This number returned to the previous level after removal of the BSW. Thus, the microbiological and epidemiological findings revealed that the outbreak was related to BSW contaminated with P. aeruginosa. It was concluded that all untested BSW should be removed from ICUs.
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德国某医院ICU病房瓶装水污染引起的铜绿假单胞菌感染爆发
Title: An outbreak of hospital-acquired Pseudomonas aeruginosa infectioncaused by contaminated bottled water in intensive care units
T. Eckmanns1, M. Oppert2, M. Martin3, R. Amorosa3, I. Zuschneid1, U. Frei2, H. Ru¨den3 and K. Weist3
1Robert Koch Institute, 2Department of Nephrology, Medical Intensive Care and 3Institute for Hygiene
and Environmental Medicine, Charite´-Universita¨tsmedizin Berlin, Humboldt University, Berlin,
Germany
ABSTRACT
This study describes an outbreak of Pseudomonas aeruginosa infections caused by contaminated bottled still
water (BSW) in six intensive care units (ICUs) of a German university hospital. Clinical and environmental
samples from these units were cultured and genotyped by amplified fragment-length polymorphism and
pulsed-field gel electrophoresis analysis. Microbiological results were reviewed on a weekly basis to
determine the number of P. aeruginosa infections and colonisations of ICU patients. Clinical specimens
from 19 ICU patients—15 infections and four colonisations—yielded the same strain of P. aeruginosa.
Furthermore, four of 103 environmental samples also yielded P. aeruginosa. However, only a P. aeruginosa
strain isolated from unopened BSW was genetically identical to the P. aeruginosa strain isolated from the
patients. In the 42-week period before the outbreak, the mean weekly number of new ICU patients infected
or colonised with P. aeruginosa was 46.9 (95% CI 40.7–53.1) ⁄ 1000 bed-days. During the 6-week period of
the outbreak, the weekly number of new patients with P. aeruginosa was 88.9 (95% CI 54.3–122.2) ⁄ 1000
bed-days. This number returned to the previous level after removal of the BSW. Thus, the microbiological
and epidemiological findings revealed that the outbreak was related to BSW contaminated with
P. aeruginosa. It was concluded that all untested BSW should be removed from ICUs.
Keywords Bottled water, genotyping, infection control, intensive care units, outbreak, Pseudomonas aeruginosa
Original Submission: 7 June 2007; Revised Submission: 25 November 2007; Accepted: 3 December 2007
Clin Microbiol Infect 2008; 14: 454–458
摘要大意：
在德国某所大学附属医院的6个ICU病房内发生了铜绿假单胞菌感染的爆发。研究人员对这些ICU临床和环境的标本进行了培养，PCR片段扩增，并做了凝胶电泳分析。从每周进行的微生物学检查结果判断出了铜绿假单胞菌感染的病例和患者的定植情况。19例ICU病人中（15例感染，4例定植）均培养出相同的菌株。此外，103例环境标本中有4例培养出铜绿假单胞菌，但只有1例来自未开封的瓶装水分离出了和患者同源的菌株。在本次爆发流行前的42周内，每周新入ICU的患者中铜绿假单胞菌感染或定植率平均为46.9/1000个住院日，在感染爆发的6周内，平均为88.9/1000个住院日。ICU病房取缔该种瓶装水后，铜绿假单胞菌感染或定植率又回到了以前的水平。因此，未经检测的瓶装水不能用于ICU病房。
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回复 #1 phswany2007 的帖子
请问这种瓶装水是干什么用的？呼吸机吗？有原文吗？回复 #2 缭绕 的帖子
此种瓶装水可能是纯化水或蒸馏水，应该是加入呼吸机湿化器的湿化液。如果是这样，那铜绿假单胞菌感染爆发就是呼吸机相关性肺炎啦。 呼吸机湿化器的湿化液应为无菌水,瓶装水不能视为无菌水吧。那个医院的瓶装水是用于病人做什么用呢？ 文献全文曾经发布过
http://bbs.sific.com.cn/viewthread.php?tid=4932&extra=page%3D2 在本次爆发流行前的42周内，每周新入ICU的患者中铜绿假单胞菌感染或定植率平均为46.9/1000个住院日，在感染爆发的6周内，平均为88.9/1000个住院日。ICU病房取缔该种瓶装水后，铜绿假单胞菌感染或定植率又回到了以前的水平。
判断暴发依据铜绿假单胞菌感染或定植率平均住院日显著改变？
回复 #8 zhangfh 的帖子
不是平均住院日，是铜绿假单胞菌感染/定植发生率，按每千住院日多少例即使，就像CRBSI。 请问是什么瓶装水？做什么用的呢？ 下载学习借鉴
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