Izbruh kolonizacij pri pacientih s proti karbapenemom odporno bakterijo Pseudomonas putida na oddelku za internistično onkologijo

Suhadolc Milković, Nina (avtor), Godič Torkar, Karmen (mentor), Kerin Povšič, Karmen (komentor)

Uvod: V zdravstvenih ustanovah se srečujemo z mikroorganizmi, katerih izvor so lahko pacienti, zdravstveno osebje ali bolnišnično okolje. V bolnišničnem okolju, predvsem v vodi, tekočinah in na vlažnih površinah, pogosto najdemo tudi bakterije rodu Pseudomonas, ki so že intrinzično odporne proti številnim antibiotikom in čistilno razkužilnim sredstvom. Pridobljena odpornost teh bakterij proti beta-laktamskim antibiotikom karbapenemom pa predstavlja zdravstvenim delavcem nov izziv, saj so možnosti zdravljenja okužb omejene. Na oddelku za internistično onkologijo smo se v obdobju od leta 2015 do leta 2017 srečali s proti karbapenemom odpornimi sevi bakterije Pseudomonas putida, ki smo jih identificirali v blatu 88 hospitaliziranih pacientov. Namen: Z raziskavo smo želeli ugotoviti izvor in poti prenosa bakterije Pseudomonas putida na oddelku za internistično onkologijo in dokazati, da pacienti niso bili kolonizirani z bakterijo Pseudomonas putida, ampak je prišlo do kontaminacije pri odvzemu blata kot nadzorne kužnine. Metode dela: Raziskavo smo izvedli v dveh delih. V prvem delu smo opisali značilnosti pacientov, pri katerih smo v nadzorni kužnini blata odkrili bakterijo Pseudomonas putida, in rezultate mikrobiološkega vzorčenja površin, vode in tekočin na oddelku za internistično onkologijo. V drugem delu smo pri kontrolnih pregledih istih pacientov ponovno odvzeli nadzorne kužnine in preverjali njihovo koloniziranost z bakterijo Pseudomonas putida. Na podlagi rezultatov mikrobiološkega vzorčenja površin prvega dela raziskave, smo se usmerili v vzorčenje notranje površine straniščnih školjk, kjer smo želeli dokazati izvor bakterije Pseudomonas putida. Rezultati: V raziskavi smo ugotovili, da je bila lahko prisotnost bakterije Pseudomonas putida v nadzornih kužninah blata posledica njihovega nepravilnega odvzema neposredno z notranje površine straniščnih školjk, na katerih smo jo z mikrobiološkim vzorčenjem tudi dokazali. Primarnega izvora te bakterije na notranji površini straniščnih školjk nismo odkrili. Razprava in sklep: Ukrepi za preprečevanje in obvladovanje okužb, povezanih z zdravstvom, so številni, od čiščenja bolnišničnega okolja do predpisovanja antibiotikov pacientom. Eden od pomembnih ukrepov je iskanje nosilcev večkratno odpornih bakterij, ki jih odkrivamo z odvzemi nadzornih kužnin, ki morajo biti odvzete skladno z internimi navodili zdravstvene ustanove in navodili mikrobiološkega laboratorija. Zdravstveni delavci morajo poznati postopek odvzema vzorca blata za mikrobiološko preiskavo in možnost napak. Kadar pacienti odvzamejo vzorec blata sami, jih morajo natančno poučiti o vseh fazah postopka. Prav tako morajo zdravstveni delavci pri svojem delu upoštevati vsa navodila in ukrepe, ki se nanašajo na obvladovanje in preprečevanje okužb, povezanih z zdravstvom.

• Jezik: Slovenski jezik
• Ključne besede: okužbe, povezane z zdravstvom, nadzorna kužnina, karbapenemaze, Pseudomonas putida, kolonizacija
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2018
• PID: 20.500.12556/RUL-101289
• COBISS.SI-ID: 5428843
• Datum objave v RUL: 22.05.2018

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Outbreak of carbapenem resistant Pseudomonas putida colonization in the department of internistic oncology

Izvleček

Introduction: In health care institutions, microorganisms that can originate from patients, healthcare workers or health care environment are present. The bacteria of the genus Pseudomanas that are already intrinsically resistant to numerous antibiotics and disinfectants can frequently be found in health care environment, mostly in water, liquids and damp surfaces. The resistance of these bacteria to beta-lactam antibiotics carbapenems is a challenge that healthcare workers are facing, as it limits the treatment options of infections. In the period from 2015 to 2017, the Department of Internistic Oncology encountered the carbapenem resistant Pseudomonas putida strains, which were found in the stool samples of 88 hospitalized patients. Purpose: The research was carried out in order to find out the origin and route of transmission of the bacterium Pseudomonas putida at the Department of Internistic Oncology and to prove that the patients were not colonised with the bacterium Pseudomonas putida but the contamination arose during the collection the stool sample as a surveillance culture. Working methods: The research was carried out in two steps. In the first step, we described the characteristics of patients, whose stool surveillance cultures showed the presence of bacterium Pseudomonas putida, and the results of microbiological sampling of surfaces, water and liquids in the Department of Internistic Oncology. In the second step, we collected the surveillance cultures of the same patients again and tested their colonization with the bacterium Pseudomonas putida. Based on the results of microbiological surface sampling in the first step of research, we focused on the sampling of the inside surfaces of toilet bowls in order to prove the source of the bacterium Pseudomonas putida. Results: The research showed that the presence of the bacterium Pseudomonas putida in the stool surveillance cultures could be the consequence of the inappropriate collection directly from the inside surfaces of the toilet bowls where its presence was proven by the microbiological sampling. The primary source of the bacterium, found on the toilet bowl surfaces, was not discovered. Discussion and conclusion: The prevention and control measures related to healthcare impose numerous measures form cleaning the health care environment to prescribing antibiotics to patients. One of the important measures is to look for the carriers of the multi-drug resistant bacteria that we identify by collecting surveillance cultures, which has to be collected in accordance with the internal instructions of health care institution and instructions of microbiology laboratory. Healthcare workers have to be familiar with the correct procedure of collecting stool samples for microbiological investigstions and the possibility for mistekes. When patients take a stool samples themselves, they need to be carefully taught about all the stages of the procedure. Healthcare workers have to follow the instructions and measures related to the prevention and control of infections in healthcare settings.

• Ključne besede: healthcare-associated infectons, control samples, carbapenemase, Pseudomonas putida, colonization.