皮氏羅爾斯頓氏菌（Ralstonia pickettii）與血液透析相關感染

Literature review of Ralstonia pickettii in hemodialysis related infection

Ralstonia pickettii（皮氏羅爾斯頓氏菌）在醫院的環境中被視為新興病原體。本身雖然為低毒力之革蘭氏陰性的桿狀土壤細菌，但R. pickettii容易於塑料管中及醫療裝置形成生物膜，並且有能力產生毒素致病，因此可能造成醫院內免疫功能不全病人的感染，尤其是發生菌血症。R. pickettii先天對多數抗生素有抗藥性，對臨床治療也是挑戰。在不同國家、不同層級的醫療機構或是洗腎中心皆有報過群聚事件，菌種主要以Ralstonia屬中跟R. pickettii相近的R. mannitolilytica為主。其感染源大多是來自洗腎用水污染，包括逆滲透過濾器的失效或是污染。一旦病人檢測出R. pickettii菌血症，應高度懷疑菌血症源於受污染的醫療產品、液體或藥物，並應積極尋找出是何種醫療產品、液體或藥物受污染。為了避免Ralstonia的生物膜繼續汙染水質，全面更換管路設備，加強消毒，並增加檢查UV燈與定期水質檢驗的頻率。臨床與實驗室應有對於不正常菌血症增加的警覺，快速正確辨認污染源而採取感染管制介入措施，方能遏止群聚感染。

Ralstonia pickettii, a gram-negative bacillus, was seldom regarded as being virulent. However, it has become an emerging pathogen in hospital settings. R. pickettii can easily form biofilms on water pipes and medical devices, and causes bacteremia in immunocompromised hosts. Treatment of R. pickettii bacteremia is challenging because there is no standard treatment. Many outbreaks of varying severity caused by R. pickettii and R. mannitolilytica have been reported in different countries, medical institutions, and dialysis centers. Contamination of medical products, liquids, or drugs should be suspected in instances of R. pickettii bacteremia. In addition to following basic infection control principles in hemodialysis units, clinicians and laboratory staff should be alert to unusual bacteremia. Rapid and accurate identification of the source of contamination is important for successful intervention.