某區域醫院鼻咽鏡Serratia marcescens污染事件之調查處理

An Investigation of Pseudo-outbreak of Serratia marcescens due to Contaminated Nasopharyngoscopes at a Regional Hospital

黏質沙雷氏桿菌（Serratia marcescens）屬於葡萄糖發酵革蘭氏陰性桿菌，是常見院內伺機性感染病原菌，可以由醫院環境中各類醫療儀器表面及材料分離出來，進而造成院內群突發感染。我們報告一件耳鼻喉科門診疑似S. marcescens群突發事件之調查處理過程與結果。於此事件中，4株臨床鼻咽拭子分離株及8株耳鼻喉科門診環境（含鼻咽鏡）採檢分離株，經脈衝式電泳法（pulsed-field gel electrophoresis, PFGE）分析指出，12株S. marcescens菌株距相同基因型，顯示耳鼻喉科門診環境及鼻咽鏡受S. marcescens交叉汙染，幸好未釀成真正群突發病人感染。落實醫院內環境感控措施，不但可保障病人的安全就醫權利，也是消弭可能發生的醫院內群突發感染事件所不可或缺的。

Serratia marcescens is a glucose-fermenting gram negative bacillus. It is a common opportunistic pathogen that may be isolated from the surfaces of medical equipment and materials and may even cause nosocomial outbreaks. We report a Pseudo-outbreak of S. marcescens due to cross contamination between our otolaryngology clinic and nasopharyngoscopes used in our hospital. By using pulsed-field gel electrophoresis analysis, we found that the 4 strains of S. marcescens isolated from nasopharyngeal swabs, and the 8 strains isolated from the environment in our otolaryngology clinic, were of the same genotype. There was no nosocomial outbreak, but these findings elucidate the importance of infection control in a hospital setting.