1987年 7月至2005年12月期间美国CDC医院感染暴发调查报告选编(1989年)

鬼才

为帮助大家对医院感染暴发的流行病学调查方法有所了解，现将我整理的美国CDC1987年7月至2005年12月对医院感染暴发流行病学调查情况，发到SIFIC论坛，共同学习，从中掌握一些感染流行病学的调查方法。因内容太多，暂不全文翻译。今后有时间，再译成中文。

1989年

1. 重症监护病房患者黏质沙雷氏菌血流感染----伊利诺斯州

Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit.Villarino ME1, Jarvis WR, O'Hara C, Bresnahan J, Clark N.
Author information

• 1Hospital Infections Program, Centers for Disease Control, Atlanta, Georgia 30333.
  

AbstractFrom 16 July through 27 September 1988, seven cases of nosocomial Serratia marcescens bacteremia occurred in a cardiac care unit. In all seven case patients, S. marcescens was isolated from blood cultures. Two of the seven had other microorganisms identified in the blood culture in which S. marcescens was recovered; one had Enterobacter cloacae, and one had Klebsiella pneumoniae. A case-control study was conducted to identify risk factors for bloodstream infection. Case patients were more likely than controls to have been exposed to an intra-aortic balloon pump pressure transducer (7 of 7 versus 6 of 21; P = 0.001) and to a pulmonary arterial pressure transducer (7 of 7 versus 8 of 21; P = 0.005). Cultures of in-use and in-storage transducers revealed bacterial contamination of the pressure-sensitive membranes of the transducers. S. marcescens blood culture isolates obtained from five of the seven case patients, as well as six S. marcescens isolates from cultured transducers, belonged to serotypes Oundetermined:H1 and Oundetermined:H18. E. cloacae isolates from one case patient and from two stored and two in-use transducers had identical antimicrobial suceptibility patterns. Review of cardiac care unit disinfection practices revealed that the transducers were not processed with high-level disinfection or sterilization between patient uses. We concluded that the transducers had served as reservoirs for this outbreak of bloodstream infection. Because intra-aortic balloon pumps with pressure transducers are being used more frequently in the management of critically ill cardiac patients, their role as infectious reservoirs should be considered in the investigation of nosocomial bacteremia.

鬼才

2. 髋关节置换患者的手术部位感染----缅因州

Outbreak of surgical wound infections associated with total hip arthroplasty.Beck-Sague CM1, Chong WH, Roy C, Anderson R, Jarvis WR.
Author information

• 1Hospital Infections Program, Centers for Disease Control, U.S. Department of Health and Human Services, Atlanta, GA 30333.
  

AbstractOBJECTIVES: Describe an outbreak of surgical wound infections associated with total hip arthroplasty; identify risk factors for surgical wound infection during the pre-outbreak and outbreak periods.
SETTING: A 100-bed hospital. From May 1 to September 30, 1988, 7 of 15 patients who underwent total hip arthroplasty developed surgical wound infections from Staphylococcus aureus (5), Enterobacter cloacae (1), beta-hemolytic streptococci (1), enterococci (1), coagulase-negative staphylococci (1), and Escherichia coli (1) (attack rate = 46.7%).
DESIGN: Retrospective cohort studies comparing surgical wound infection rates by patient- and procedure-related risk factors during the pre-outbreak and outbreak periods were conducted. Drop plate quantitative air culturing was conducted in 10 consecutive total hip arthroplasties in the subsequent 6 months.
RESULTS: Rates of surgical wound infection were surgically higher for arthroplasties in which no intraoperative prophylactic antimicrobials were given (44% versus 8%, relative risk [RR] = 5.4, p = .01), or in which the posterior approach (20% versus 3%, RR = 6.7, p = .04) or a specific prosthesis (39% versus 5%, RR = 6.3, p = 0.01) was used. The surgical wound infection rate was highest when one circulating nurse, Nurse A, assisted (47% versus 4%, RR = 12.8, p less than .001). Logistic regression analysis identified use of the posterior approach (RR = 1.8, p = .04) and Nurse A's participation (RR = 5.0, p less than .001) as independent risk factors for surgical wound infection. Interviews of the nursing supervisor indicated that Nurse A had recurrent dermatitis on her hands. During 6 months following Nurse A's reassignment, the rate declined significantly (from 7/15 to 0/10, p = .01). Drop plate culturing yielded 2 to 10 colonies per plate of organisms that did not match outbreak organisms.
CONCLUSIONS: Outbreaks associated with personnel generally involve only 1 species. In this outbreak, Nurse A (possibly because of her dermatitis), technique, the posterior approach, and/or other undetermined factors were the primary predictors of surgical wound infection.

鬼才

3. 血液透析患者低血压----纽约州
Epidemic hypotension in a dialysis center caused by sodium azide.Gordon SM1, Drachman J, Bland LA, Reid MH, Favero M, Jarvis WR.
Author information

• 1Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia.
  

AbstractThe water used for dialysate (dialysis fluid) in hemodialysis centers is produced by water treatment systems (WTS), which require careful and frequent monitoring. On November 3, 1988, nine patients receiving hemodialysis treatments at a single dialysis center suddenly developed hypotension within 30 minutes of onset of dialysis. Eight patients exhibited symptoms and two experienced syncopal episodes; there were no deaths. The incidence of dialysis-associated hypotension occurring within 30 minutes after dialysis onset for these patients was significantly higher during outbreak treatments than during preoutbreak (September 1 through November 2, 1988) treatments, (9 of 9 vs. 0 of 238, P less than 0.00001, Fisher's t-test). Sodium azide, a potent hypotensive agent, was identified as the probable contaminant within the WTS of the dialysis center at the time of the outbreak because: 1) it was mixed with glycerine as the preservative solution of each of the four ultrafilters that were put on-line in the WTS without rinsing, 12 hours before the outbreak; and 2) high levels of total organic carbons were detected from dialysis water collected at point-of-use sites at the time of the outbreak, suggesting contamination of the WTS with the sodium azide-glycerine preservative solution. To prevent similar occurrences, we recommend that ultrafilters (and other components of the WTS) be rinsed free of potentially toxic chemicals prior to use. Dialysis center personnel need to be aware of the potential affects that each modification of disinfection of the WTS may have upon the product water used to prepare dialysate for patient treatments.

鬼才

4. 新生儿重症监护病房新生儿甲型肝炎感染----夏威夷州
Hepatitis A outbreak in a neonatal intensive care unit: risk factors for transmission and evidence of prolonged viral excretion among preterm infants.Rosenblum LS1, Villarino ME, Nainan OV, Melish ME, Hadler SC, Pinsky PP, Jarvis WR, Ott CE, Margolis HS.
Author information

• 1Hepatitis Branches, Centers for Disease Control, Atlanta, GA 30333.
  

AbstractAn outbreak of hepatitis A virus (HAV) infection in a neonatal intensive care unit (NICU) provided the opportunity to examine the duration of HAV excretion in infants and the mechanisms by which HAV epidemics are propagated in NICUs. The outbreak affected 13 NICU infants (20%), 22 NICU nurses (24%), 8 other staff caring for NICU infants, and 4 household contacts; 2 seropositive infants (primary cases) received blood transfusions from a donor with HAV infection. Risk factors for infection among nurses were care for a primary infant-case (relative risk [RR], 3.2), drinking beverages in the unit (odds ratio [OR], infinity), and not wearing gloves when taping an intravenous line (OR, 13.7). Among infants, risk factors were care by a nurse who cared for a primary infant-case during the same shift (RR, 6.1). Serial stool samples from infant-cases were tested for HAV antigen (HAV-Ag) by enzyme immunoassay and HAV RNA by nucleic acid amplification using the polymerase chain reaction. Infant-cases excreted HAV-Ag (n = 2) and HAV RNA (n = 3) 4-5 months after they were identified as being infected. Breaks in infection control procedures and possibly prolonged HAV shedding in infants propagated the epidemic in a critical care setting.

鬼才

5. 婴儿洋葱假单胞菌假性菌血症----德克萨斯州
Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia.Panlilio AL1, Beck-Sague CM, Siegel JD, Anderson RL, Yetts SY, Clark NC, Duer PN, Thomassen KA, Vess RW, Hill BC, et al.
Author information

• 1Investigation and Prevention Branch, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia.
  

AbstractIn 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.

鬼才

6. 重症监护病房患者嗜麦芽单胞菌感染----犹他州
Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.Villarino ME1, Stevens LE, Schable B, Mayers G, Miller JM, Burke JP, Jarvis WR.
Author information

• 1National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
  

AbstractOBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.
DESIGN: Surveillance and cohort study.
SETTING: A 470-bed tertiary trauma-referral community hospital.
PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization greater than or equal to 48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for greater than or equal to 72 hours during the epidemic period who had no X maltophilia-positive culture).
RESULTS: Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk = 1.3, p = .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient's room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel's hands. Related environmental and clinical isolates were serotype 10.
CONCLUSIONS: Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.

鬼才

7.人类免疫缺陷病毒感染患者多重耐药结核分枝杆菌感染----波多黎各
Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients.Dooley SW1, Villarino ME, Lawrence M, Salinas L, Amil S, Rullan JV, Jarvis WR, Bloch AB, Cauthen GM.
Author information

• 1Division of Tuberculosis Elimination, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
  

AbstractOBJECTIVE: To assess nosocomial transmission of tuberculosis (TB).
DESIGN: A historical cohort study of hospitalized patients with the human immunodeficiency virus (HIV) and a purified protein derivative (PPD) tuberculin skin test survey of health care workers (HCWs).
SETTING: A large public teaching hospital in San Juan, Puerto Rico.
PATIENTS: For the cohort study, a case patient was defined as any patient in the HIV unit at the hospital who developed culture-positive TB from 31 days or more after admission through December 31, 1989. For the PPD survey, of 1420 HCWs from the hospital, 908 agreed to participate and had sufficient data for analysis.
MAIN OUTCOME MEASURES: For the cohort study, to compare the risk of developing active TB among patients who were exposed to hospital roommates with infectious TB and the risk among nonexposed patients. For the HCW PPD survey, to determine the prevalence of and risk factors for tuberculous infection.
RESULTS: Eight of 48 (9.7/10,000 person-days) exposed case patients vs four of 192 (0.8/10,000 person-days) nonexposed case patients developed active TB (relative risk [RR] = 11; 95% confidence interval [CI], 2.3, 50.3). Positive PPDs (greater than or equal to 10 mm of induration) in HCWs were associated with older age (P = .0001) and with history of community TB exposure (P = .0002). In a multivariable logistic model that adjusted for these variables, HIV unit nurses (nine of 19) and nurses in the internal medicine ward (45 of 90) had a higher proportion of positive PPDs than the reference group (clerical personnel on other floors: 35 of 188, P = .0005).
CONCLUSIONS: These data suggest that patient-to-patient transmission of TB in HIV units can occur and that HCWs are at risk of acquiring TB infection.

鬼才

8. 居民长期护理机构的医院感染----加利福尼亚州
Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes.Beck-Sague C1, Villarino E, Giuliano D, Welbel S, Latts L, Manangan LM, Sinkowitz RL, Jarvis WR.
Author information

• 1Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333.
  

AbstractAn increasing proportion of the U.S. population resides in nursing homes (NHs). No surveillance system exists for infections in these facilities. To determine the incidence and types of infections in NH residents, and to identify predictors of death among residents with infections, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990. The study included 1754 residents, among whom 835 infections were identified during the study period. The most common infections were urinary tract infections (UTIs; 286, 34.2%), respiratory tract infections (RTIs; 259, 31%), and skin infections (150, 17.9%). Of the 259 residents with respiratory tract infections, 69 (27%) had pneumonia. Antimicrobials were prescribed for 646 (77%) of the infectious episodes. Residents with pneumonia were more likely to die than residents with other infections (4 of 69 versus 12 of 766; P = 0.04). Symptoms of altered body temperature (fever, hypothermia, chills) and change in mental status also were associated with an increased risk of a fatal outcome (10 of 260 versus 6 of 575; P = 0.01) and (7 of 127 versus 9 of 708; P = 0.004). This study suggests that the most common infections among NH residents are UTIs, RTIs, and skin infections. Pneumonia, symptoms of fever, and mental status changes all were associated with increased mortality. The frequency of infections among NH residents and their impact on resident outcome highlights the need for infectious disease surveillance in this population.

鬼才

9. 血液透析患者过敏反应----弗吉尼亚州
Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors.Pegues DA1, Beck-Sague CM, Woollen SW, Greenspan B, Burns SM, Bland LA, Arduino MJ, Favero MS, Mackow RC, Jarvis WR.
Author information

• 1Hospital Infections Program, Centers for Disease Control, Atlanta, Georgia.
  

AbstractFrom July 18 through November 27, 1989, 12 anaphylactoid reactions (ARs) occurred in 10 patients at a hemodialysis center in Virginia. One patient required hospitalization; no patients died. ARs occurred within minutes of initiating dialysis and were characterized by peripheral numbness and tingling, laryngeal edema or angioedema, facial or generalized sensation of warmth, and/or nausea or vomiting. All 12 ARs occurred with dialyzers that had been reprocessed with an automated reprocessing system. A cohort study, including all patients undergoing dialysis sessions on the six days when an AR occurred, showed that the patients who experienced ARs were significantly more likely than patients who did not to be treated with angiotensin-converting enzyme (ACE) inhibitors (7/10 vs. 3/33; relative risk = 7.9; 95% confidence interval = 2.5 to 25.2) and to have been exposed to reused dialyzers rather than to new dialyzers (12/70 sessions vs. 0/31; P = 0.016). In those sessions using a reused dialyzer, the mean number of dialyzer uses in case-sessions was significantly higher than for noncase-sessions (10.3 vs. 6.2; P = 0.016). After reuse of dialyzers was discontinued at the center, no further ARs occurred, despite the continued administration of ACE inhibitors. This is the first report of an outbreak of ARs associated exclusively with reused dialyzers. We hypothesize that interactions between a dialyzer that has been repeatedly reprocessed and reused, blood, and additional factors, such as ACE inhibitors, increased the risk of developing ARs.

苏菲亚

鬼才 发表于 2014-4-25 11:47
9. 血液透析患者过敏反应----弗吉尼亚州
Anaphylactoid reactions associated with reuse of hollow-fiber ...

好资料，谢谢鬼才斑斑，如果是中文的资料就更好了

xucongzhu

楼主还真是有心整理，谢谢提供消息，不过这个在哪里能看到的呢？楼主最早是从那里得知的？

鬼才

xucongzhu 发表于 2015-1-27 15:27
楼主还真是有心整理，谢谢提供消息，不过这个在哪里能看到的呢？楼主最早是从那里得知的？

来源于各种文献的学习，通过文献中的信息，浏览国外网站收集信息，整理而成。因得不到全文数数据库，是件遗憾的事。

xucongzhu

鬼才 发表于 2015-2-15 13:26
来源于各种文献的学习，通过文献中的信息，浏览国外网站收集信息，整理而成。因得不到全文数数据库，是件 ...

恩恩，是的呀，感染暴发这块国内还是做的比较少，看看文献很有帮助呢，就是要文献还要花钱购买很麻烦呢

esuoting

看到发的几篇的都是比较早的，有没有更新的呢？可以借鉴一下感染暴发后的调查分析方法啊

esuoting

看到发的几篇的都是比较早的，有没有更新的呢？可以借鉴一下感染暴发后的调查分析方法啊

鬼才

esuoting 发表于 2015-9-12 11:03
看到发的几篇的都是比较早的，有没有更新的呢？可以借鉴一下感染暴发后的调查分析方法啊

这些文献是感染暴发流行病学研究的经典范例。但遗憾的是我一直没找到这些文献的全文。
关于文献的更新问题，不能认为新的文献就比旧的文献好。一篇文献的学术价值需要经受时间的检验。如我最近在进行一些统计学基础理论方面的探讨，我所参阅的文献大部分是三十多年前的文献，有部分还是60多年前的文献。做学术研究，只有充分吸收前人的研究成果，理解他们研究问题的思想，才有所创新。我们使终要记住一句话，学术研究是一项严谨的工作。

鬼才

esuoting 发表于 2015-9-12 11:04
看到发的几篇的都是比较早的，有没有更新的呢？可以借鉴一下感染暴发后的调查分析方法啊

如果要学习感染暴发调查分析方法，建议阅读一些流行病学方面的书籍，学习阅读的范围一定要广。

esuoting

谢谢回复，赞成您的想法，找到了第一篇全文，其它几篇正在查找中，有的话继续分享

esuoting

鬼才 发表于 2015-9-12 13:05
如果要学习感染暴发调查分析方法，建议阅读一些流行病学方面的书籍，学习阅读的范围一定要广。

回复见楼上

鬼才

esuoting 发表于 2015-9-19 10:58
谢谢回复，赞成您的想法，找到了第一篇全文，其它几篇正在查找中，有的话继续分享

非常感谢，有您的帮助，我准备把这个专题系列继续做下去。