ICU中耳念珠菌的爆发流行及其控制

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[NEJM论文]：ICU中耳念珠菌的爆发流行及其控制
2018年10月18日
ORIGINAL ARTICLE
A Candida auris Outbreak and Its Control in an Intensive Care Setting
David W. Eyre, Anna E. Sheppard, Hilary Madder, et al
N Engl J Med 2018; 379:1322-1331
DOI: 10.1056/NEJMoa1714373
Abstract
BACKGROUND 背景
Candida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection.

耳念珠菌是一种新出现的多重耐药致病菌。我们报告了医院内爆发耳念珠菌定植与感染的流行病学。

METHODS 方法
After identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing.

在英国牛津大学医院神经重症ICU鉴定了一组耳念珠菌感染后，我们开始了针对患者及环境的强化筛查计划，并实施一系列干预措施。我们采用多因素logistic回归确定耳念珠菌定植与感染的预测因素。采用全基因组测序对来自患者及环境的菌株进行分析。

RESULTS 结果
A total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P<0.001) and systemic fluconazole exposure (multivariable odds ratio, 10.34; 95% CI, 1.64 to 65.18; P=0.01). C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes. Despite a bundle of infection-control interventions, the incidence of new cases was reduced only after removal of the temperature probes. All outbreak sequences formed a single genetic cluster within the C. auris South African clade. The sequenced isolates from reusable equipment were genetically related to isolates from the patients.

2015年2月2日至2017年8月31日间，共有70例患者发生耳念珠菌的定植或感染；其中，66例(94%)诊断前曾入住神经重症ICU。7例患者发生侵袭性耳念珠菌感染。对神经重症ICU住院时间及患者生命体征和实验室检查结果进行校正后，耳念珠菌定植或感染的预测因素包括使用重复使用的腋温探头（多因素比数比，6.80；95% 可信区间 [CI]，2.96 to 15.63；P<0.001）及全身使用氟康唑（多因素比数比，10.34；95% CI，1.64 to 65.18；P=0.01）。一般环境中很少检测到耳念珠菌。然而，在重复使用的设备（包括多个腋温探头）上分离到耳念珠菌。尽管采取了一系列感染控制措施，但是，仅当弃用了温度探头后，新发病例才开始减少。爆发流行的所有序列来自耳念珠菌南非分支的一个遗传聚类。从重复使用设备分离的耳念珠菌与来自患者的分离株呈遗传学相关。

CONCLUSIONS 结论
The transmission of C. auris in this hospital outbreak was found to be linked to reusable axillary temperature probes, indicating that this emerging pathogen can persist in the environment and be transmitted in health care settings.

医院爆发流行中，耳念珠菌的传播与重复使用的腋温探头有关，提示这种新出现的致病菌可能持续存在于环境中，并在院内传播。

(Funded by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University and others.)

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