内窥镜相关的oxa -181-碳青霉烯酶产生肺炎克雷伯菌暴发及其对卫生管理的影响

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-02-07 DOI:10.1016/j.jhin.2025.01.016

J. Haak , I. Klempien , J.B. Hans , S. Schaefer , K. Meyer-Bothling , S. Gatermann , E.E. Dirks , K. Konrat , M. Arvand

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引用次数: 0

摘要

目的：报道一起与胃肠内镜相关的碳青霉烯耐药肺炎克雷伯菌大爆发的流行病学、微生物学和遗传学调查，包括感染控制措施。方法：对后处理流程进行内外部审核，对后处理内窥镜进行系统的微生物学检查，更换旧内窥镜，对拆解的内窥镜进行通道调查，对暴发菌株进行生物膜消毒效果检测，进行全基因组测序（WGS）分析。结果：在暴发早期，19例患者检出暴发菌株，其中16例（84%）接受了胃肠道内镜检查。该菌株也从重新处理的内窥镜中分离出来。WGS证实了分离株的克隆相关性，并建议通过污染的内窥镜在患者之间传播。对后处理进行了审核，用新内窥镜代替旧内窥镜，并介绍了新内窥镜的系统微生物检查。在随访中，从重新处理后的新内窥镜中分离出爆发菌株。重复审核发现再加工后内窥镜通道中残留水分。对拆卸的内窥镜进行检查，发现通道上有碎片和划痕。消毒剂药效试验显示，暴发菌株的生物膜对过氧乙酸具有耐受性。总共从32名患者和两个重新处理的内窥镜中分离出爆发菌株。世卫组织建议，在疫情后期，患者间传播是传播途径。结论：需要采取多阶段战略来控制此次疫情。显微镜分析显示在内窥镜通道中形成生物膜的证据，暴发菌株的生物膜对用于再处理的消毒剂具有耐受性。我们的数据强调了在感染控制实践和内窥镜再处理方案中继续保持警惕的必要性。

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Endoscope-associated outbreak of OXA-181-carbapenemase-producing Klebsiella pneumoniae and its implications for hygiene management

Aim

To report the epidemiologic, microbiologic and genetic investigation of a large outbreak of carbapenem-resistant Klebsiella pneumoniae associated with gastrointestinal endoscopy, including infection control interventions.

Methods

Internal and external audits of reprocessing procedure, systematic microbiological examination of reprocessed endoscopes, replacement of old endoscopes, investigation of channels of a dismantled endoscope, disinfectant efficacy testing on the outbreak strain's biofilm, and whole-genome sequencing (WGS) analysis were performed.

Findings

In the early phase of the outbreak, the outbreak strain was detected in 19 patients, 16 (84%) of whom had undergone gastrointestinal endoscopy. The strain was also isolated from a reprocessed endoscope. WGS confirmed clonal relatedness of isolates and suggested transmission between patients via contaminated endoscopes. The reprocessing was audited, old endoscopes were replaced with new ones, and systematic microbiological examination of new endoscopes was introduced. In the follow-up, the outbreak strain was isolated from a new endoscope after reprocessing. Repeat audit revealed residual moisture in endoscope channels after reprocessing. Inspection of a dismantled endoscope revealed debris and scratches in channels. Disinfectant efficacy testing revealed tolerance of the outbreak strain's biofilm to peracetic acid. The outbreak strain was isolated from 32 patients and two reprocessed endoscopes. WGS suggested patient-to-patient as route of transmission in the outbreak's later phase.

Conclusions

A multi-stage strategy was required to contain this outbreak. Microscopic analysis showed evidence of biofilm formation in endoscope channels and the outbreak strain's biofilm showed tolerance to the disinfectant used for reprocessing. Our data underscores the need for continued vigilance in infection control practices and reprocessing protocols for endoscopes.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.