| 中文摘要 |
假單胞菌屬（Pseudomonas spp.），特別是綠膿桿菌（P. aeruginosa），是內視鏡採檢的常見菌種，文獻報告多起包括敗血症等院內感染事件。自2010年開始，在臺灣中部某教學醫院的內視鏡採檢連續數次培養分離綠膿桿菌，依據作業規範執行清潔與高層次消毒後採檢仍持續培養綠膿桿菌。自2011年4月至2013年2月於內視鏡管腔和自動化內視鏡再處理機（automated endoscope reprocessor, AER）共分離出18株假單胞菌，其中包含綠膿桿菌15株，經執行脈衝電泳法（pulsed-field gel electrophoresis, PFGE）分析，9株綠膿桿菌屬於同源菌株（clone type1），均來自執行經內視鏡逆行性膽胰管攝影術（ERCP）的同一十二指腸鏡（TJF-2）並於不同時段採檢檢體培養，另2株綠膿桿菌則屬於另一同源菌株（clone type2）。由於經過多次高層次消毒仍陸續自TJF-2採樣，都分離到同源菌株，因此自2013年6月3日開始停用TJF-2。自2014年之後即未曾於其他十二指腸鏡採檢發現綠膿桿菌。統計2009年至2020年內視鏡和AER定期採檢培養資料，發現在2010～2014和2019～2020致病性菌株（包含綠膿桿菌）分離數量增加，分別集中於十二指腸鏡和胃腸鏡，而大腸鏡和AER分離菌株數明顯偏低。本次研究發現綠膿桿菌可以長期移生在單一內視鏡，不易由常規清潔和高層次消毒措施去除，因此停用經多次高層次消毒仍持續被致病菌污染的內視鏡，可以避免發生持續汙染和院內感染群聚事件，並可催化發展新型內視鏡高層次消毒措施並評估成效，以作為未來修訂內視鏡感染控制措施的重要依據。 |
| 英文摘要 |
Pseudomonas aeruginosa was frequently isolated from endoscopic sampling and occasionally caused nosocomial infections. Appropriate procedures for cleaning and high-level disinfection, according to guidelines and manufacturer suggestions, were recommended. A total of 18 pseudomonas isolates, including 15 for P. aeruginosa, two for P. putida, and one for P. rettgeri were serially identified in cultures during routine endoscope sampling, after standard cleaning and disinfection, from April 2011 to February 2013. Among them, nine isolates of P. aeruginosa were recovered from the same endoscope (TJF-2). Six pulse-field gel electrophoresis (PFGE) patterns were found, among which nine P. aeruginosa isolates harbored the same PFGE pattern. The use of the contaminated TJF-2 endoscope was discontinued because of the persistent P. aeruginosa colonization despite adequate cleaning and disinfection. No pseudomonas, including P. aeruginosa, were recovered after discarding the contaminated TJF-2 endoscope. In conclusion, P. aeruginosa may cause persistent colonization and subsequent contamination of endoscopes. Fingerprinting techniques, such as PFGE, provides a practical way to identify clusters of infection and instrumental contamination. |
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