從剖腹產傷口感染個案的化膿性分枝桿菌（Mycobacterium abscessus）引發環境調查及處理報告

Investigation of Environment Sources and Management of Cesarean Section Wound Infection Caused by Mycobacterium abscessus

感染管制課接獲某單位通知，發現三位剖腹產之產婦，傷口癒合不佳且有化膿，傷口培養結果為非結核分枝桿菌（Non-tuberculous mycobacterium, NTM），因此進行產房相關環境調查及感染個案分析。個案NTM菌株進一步經分子生物學鑑定為Mycobacterium abscessus，PFGE皆為同型，個案在住院及門診期間進行抗生素治療達半年之久。環境調查方面，共計採檢16件環境檢體，將檢體進行快速型分枝桿菌及一般細菌培養鑑定，結果顯示：（1）在刷手檯水質之檢驗培養發現快速生長型NTM，進一步鑑定其為Mycobacterium chelonae，細菌量為270 CFU／ml；（2）其他15件環境檢體，快速生長型NTM陽性率為0%，但胎心音測聽器之探頭及執行清潔皮膚之肥皂液皆培養出腸內菌及大腸桿菌，細菌量500 CFU／g，已開封之超音波傳導膠亦培養出腸內菌，細菌量200 CFU／g。後續完成環境消毒及更換傳導膠，即未有新個案發生。由分析結果推論，水質及環境污染是導致本次NTM感染之重要因素，因此，醫療各環節之無菌性，可減少醫療照護相關感染之風險，維護病人安全以提升醫療照護品質。

Infection Control Practitioners (ICPs) were informed of three cases of cesarean section with poor wound healing and drainage, whose wound cultures revealed non-tuberculous mycobacteria (NTM). Because it was a rare condition, and suspected clustering of cases happened, the ICPs began to performed epidemiological investigations, including testing multiple sites for environmental cultures. In total, three patients with cesarean section wounds infected by NTM were identified. Later, these NTMs were identified as M. abscessus by using molecular methods. A total of 16 specimens collected from the medical environment were sent to the laboratory for bacterial and mycobacterial cultures. Through the microbiological survey: (1) the tap water and hand brush culture yielded M. chelonae, with a positive rate of 100% (1/1), 270 CFU/mL; (2) the sonogram probe for fetal heart beats and the cleansing liquid soap solution where found to have enteric bacteria and Escherichia coli at a rate of more than 500 CFU/g. The gel for ultrasound conduction was contaminated with enteric bacteria, 200 CFU/g. Medical environmental pollution is an important factor leading to non-tuberculous mycobacterial infection. Therefore, prompt identification of the source of infection and the use of sterile medical materials and sterile water during a cesarean section procedure is critical for medical practice and for the cleansing and disinfection processes. This will not only prevent healthcare associated infections but also promote patient safety and improve the quality of health care.