45
( Pseudomonas aeruginosa )
1-3
2 , 4 - 5
6-7
8
4 5
(Pseudomonas aeruginosa )
2003 11 pan-
drug resistant Pseudomonas aeruginos (PDRPA) 2003 1~10
2003 11 2004 1 6 PDRPA
(Chi-square) (p
0.05 ) 2003 1 30
1 43
PDRPA (PFGE)
18 1 3
( ) ( Outbreak)
Pseudomonas aeruginosa
9
carbapenem imipenem
3 cephalosporins Imipinem
12~20%
Pan-drug resistant Pseudomonas aeruginos
( PDRPA ) PDRPA
10
6-7 PDRPA
11
1~6 / (
) PDRPA 2~3
0~1 2003 11 PDRPA
2003 1~10
( )
( p 0.05 )
2003 1 1 2004 4 30
( retrospective study ) 2003 1 ~2004
1 48
PDRPA
( Chi-
square ) 2004 1 30
82
1. 1 ~ 1 5
2. - - 2 0 0 3 / 1 0 / 0 3 7
3. - -
16 17
PDRPA
fermenting gram-negative bacilli; NFGNB )
1 2
NCCLS ( National Committee for Clinical Laboratory Standards ) 13
2003 3 ~2004 2 43 PDRPA
( PFGE ) 0.5%
SeaPlaque GTG ( FMC BioProducts, Rockland, Maine, USA )
14 20 XbaI 37
6 ( Biolabs, Beverly, MA, USA ) CHEF-DR ( Bio-Rad Laboratories, Hercules, CA, USA ) 1% SeaKem GTG
( FMC BioProducts ) 0.5 Tris-borate-EDTA
22
5 12 6
14 DNA ethidium
bromide lambda
DNA ladder ( Amersham Pharmacia Biotech, Piscataway, NJ, USA )
0
2-3 4-6 7
15-16
( ) 16
4 7 2
1 15
2003 6~8 SARS
3
2003 1 ~2004 1
1 ~ 6 2 0 0 4 1 0
11
PDRPA 2 0 0 3 1 ~ 1 0
0~2 2003 11 P-
DRPA 1 3
( colonization )
5 6
2003 12
3 6 1
2 1 1
1 3
2004 1 PDRPA
2 2
6 7
4 5 1 1
1 1
( ) 2003 11
PDRPA
2003 12
2 0 0 4 1
3 P-
DRPA 6
PDRPA
33.3%
16.7% 4
PDRPA
PDRPA 4
2 0 0 3 1 3 0
( )
6
2 3 1 6
9 11
5
1 0 2
82
82 PDR-
PA 9 8
1
( retro- spective study )
2003 10 3 7 75
( ) PDRPA
PDRPA 8
P D R PA
PDRPA 16 17 PDRPA
LRI( ) BSI(
) S k i n ( ) U T I ( )
spt( ) pus( )
tip( ) ear( )
PDRPA
PDRPA
3 0
2 0
1 0
3 1
7 2
5 2
3 1
3 2
2 0
9 0
7 0
1 1
4 0
4 0
3 0
3 0
3 0
2 0
5 0
10 1
2 0
( )
( 104 )
PDR PA 104 PDR PA
2003 3 ~2004 2 43 PDRPA ( PFGE )
( )
43 PDRPA 1
PFGE
1 8 1
3 3 6
1 0 4
( )
4 1 2
67~90% 5
ventilator associated pneumonia
( VAP ) PDRPA VAP
2003 11
PDRPA
PDRPA
( Antigerm )
500ppm
( cohort program ) PFGE
4 3 P D R P A 1
(PFGE) 19
3 3 6
1 0 4 (
)
( Hibisol )
500ppm ( 0.05% )
12 2004
1 P D R P A
2 0 0 4 1 3 0
PDRPA
( Hibisol )
PDRPA
2 0 0 4 3 1 2
2004 4 1 3
PDRPA
1.Harris AD, Perencevich E, Roghmann MC, Morris G, Kaye KS, Johnson JA. Risk factors for piperacillin-resistant Pseudomonas aeruginosa among hospital patients. Antimicrob Agents Chemother 2002; 46: 854-8.
2.Takeyama K, Kunishima Y, Matsukawa M, et al. Multidrug-re- sistant Pseudomonas aeruginosa isolated from the urine of pa- tient with urinary tract infection. J infect Chemother 2002; 8:
59-63.
3.Giamarellos Bourboulis EJ, Sambatakou H, Galani I. In vitro in- teraction of colistin and rifampin on multidrug-resistant Pseudomonas aeruginosa. J Chemother 2003; 15: 235-8.
4.Yin XH, Miakamo H,Tamaya T. Nosocomial infection potency of imipenem-resistant Pseudomonas aeruginosa isolated from obstetric and gynecologic infections. J Infect Chemother 2003;
9: 97-100.
5.
1996; 262-4
6.Verweij PE, Biji DM, Melchers JG, et al. Pseudo-outbreak of multiresistant Pseudomonas aeruginosa in a hematology unit.
Infect Control And Hosp Epidemiol 1997; 18: 128-31.
7.Buttery JP, Alabaster SJ, Heine RG, et al. Multiresistant Pseudomonas aeruginosa outbreak in a pediatric oncology ward related to bath toys. Pediatr Infect Dis J 1998; 17: 509-13.
8.Erdem I, Kaynar-Tascioglu J, Kaya B, Goktas P. The compari- son of in the vitro effect of imipenem or meropenem combined with ciprofloxacin or levofloxacin against multidrug-resistant Pseudomonas aeruginosa stains. Int J Antimicrob Agents 2002;
20: 384-6.
9.Trouillet JL, Vuagnat A, combes A, Kassis N, Chastre J, Gibert C. Pseudomonas aeruginosa ventilator-associated pneumonia:
comparison of episodes due to piperacillin-resistant versus piperacillin-susceptible organisms. Clin Infect Dis 2002; 34:
1047-54.
10.Muller-premru M, Lejko-zupanc T. Epidemiological typing of imipenem-resistant Pseudomonas aeruginosa . Int J Antimicrob Agents 2002; 20: 380-3.
11.Okazaki M, Suzuki K, Asano N. Effectiveness of fosfomycin combined with other antimicrobial agents against multidrug-re- sistant Pseudomonas aeruginosa isolates using the efficacy time index assay. J Infect Chemother 2002; 8: 37-42.
12. 9
2002; 752-70.
13.National Committee for Clinical Laboratory Standards.
The Outbreak of Pan-drug Resistant
in a Medical Intensive Care Unit of Medical Center in Northern Taiwan
Chiu-Fen Chiang1, Chang-Pan Liu1,2,3,4, Nai-Yu Wang3, and Chun-Ming Lee1,2,4,5
is well recognized as a nosocomial pathogen, and has inherent drug resistance.
Compared with community-acquired strains, nosocomially acquired isolates tend to be more resistant (often, to multiple classes of antibiotics). In a medical intensive care unit of a medical center in the northern Taiwan, the number of the cases of PDRPA infections and colonization has apparently increased since November, 2003, if compared with the number of those from January, 2003 to October, 2003. From November, 2003 to January, 2004, six PDRPA-infected cases were enrolled in the study according to the stan- dard definition of nosocomial infection. By means of chi-square, the above cases were regarded as meaningful (p<0.05) in statistics and therefore this led to suspicion of the outbreak infection. The situation was immediately investigated and handled, and specimens were taken from environment on January 30, 2003. Among them, one positive specimen with the most infectious meaning was selected to be analyzed by pulsed field gel electrophoresis (PFGE), together with 43 PDRPA specimens from the medical intensive care unit. The two kinds of specimens were also compared by DNA fragments. Number of different bands less than 3 was found between the positive specimen from environment and 18 specimens from patients. The result showed there was high relevance be- tween the two kinds of isolates. Thus the outbreak of nosocomial infection was confirmed. Because the infection source and transmission route were fully understood, so the infection control measures were well reinforced and the outbreak was soon under control. ( J Intern Med Taiwan 2005; 16: 84-90 )
1Infection Control Center,2Department of Medicine,
3Microbiology Section, Department of Medical Research, Mackay Memorial Hospital,
4Mackay Junior College of Nursing, 5Taipei Medical University
Pseudomonas Aeruginosa
Pseudomonas aeruginosa
Pseudomonas aeruginosa
