內科加護病房Chryseobacterium indologenes群突發感染事件調查

Outbreak of Chryseobacterium indologenes in a medical intensive care unit at a tertiary hospital in southern Taiwan: epidemic investigation and containment

Chryseobacterium indologenes原名為Flavobacterium indologenes，會產生黃色色素的革蘭氏陰性桿菌，非人類的正常菌叢，具有多重抗藥特性。某醫學中心內科加護病房於2013年10月1日至12月31日，共7人C. indologenes醫療照護相關感染或移生。為了解感染來源及移生情形，故進行環境採檢及病人痰液主動篩檢。經分子生物學方法鑑定為同源菌株，確認為群突發事件。調查發現人員未落實手部衛生及感染管制相關措施。經由手部衛生的再教育、環境及用物以高濃度漂白水浸泡或擦拭、污物室污水槽移除外接水管、嚴禁醫療照護物品直接接觸地板等感染管制措施，追蹤至2014年1月31日無新增個案，成功控制本次群突發事件。

Chryseobacterium indologenes, formerly known as Flavobacterium indologenes, is a yellow pigmented, filamentous, and non-motile Gram-negative bacillus that can be found in soil, plants, foodstuffs, and water sources in both community and hospital settings. Between October and December 2013, a significant increase in hospital-acquired infection (HAI)/colonization due to C. indologenes was found at a medical intensive care unit (ICU) of a tertiary hospital in southern Taiwan. These cases of HAI/colonization involved a total of 7 patients with post-surgical wound infections, pneumonia, and/or bacteremia. On-site inspection found that hand hygiene and infection control measures were not strictly implemented. C. indologenes was identified in 4 environmental samples and 4 specimens from the inpatients in the ICU. All isolates, including those from patients, demonstrated identical PFGE patterns. Staff re-education, removal of the contaminated water pipe, and daily cleaning of the environment with hypochlorite solutions successfully terminated the outbreak.