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美国CDC监测发现，耳念珠菌(Candida auris)在医院内传播
2017年06月10日 ⁄ 时讯速递,
C auris: CDC Warns of Institutional Spread, Updates Guidance
Janis C. Kelly
May 18, 2017
The emerging and often drug-resistant fungus Candida auris continues to spread in the United States, the Centers for Disease Control and Prevention (CDC) reported today. Less than a year after the first seven cases of C auris were reported in the United States, the agency now says there have been 77 patient cases, and another 45 cases have been identified via close-contact screening through May 12, 2017.
疾病控制预防中心(CDC)今天报告，新出现且常常耐药的耳念珠菌在美国持续传播。美国首次报告7例耳念珠菌感染患者后不到一年，2017年5月12日CDC报告又发生77例感染病例，另有45例患者被确认为密切接触者接受筛查。
The report, published May 19 in Morbidity and Mortality Weekly Report, also provides updated recommendations for reducing the spread of C auris, with a new emphasis on interrupting transmission within healthcare facilities. This change reflects new data on environmental contamination and the risk for C auris transmission among close contacts, such as patients on the same ward.
这份报告发表在5月19日的Morbidity and Mortality Weekly Report，同时还提供了有关减少耳念珠菌传播的新的推荐意见，强调及时终止医院内传播。这一改变基于有关环境污染的新数据，以及密切接触者（如同病房的其他患者）发生耳念珠菌传播的风险。
Of the 122 cases, most were from healthcare facilities in three geographic areas, New York, New Jersey, and Illinois. Most patients were chronically ill and had long stays at high-acuity skilled nursing facilities, such as those providing mechanical ventilation, Sharon Tsay, MD, from the CDC's National Center for Emerging and Zoonotic Infectious Diseases, and colleagues report.
CDC全国新发及人畜共患传染病中心的Sharon Tsay博士及其同事报告，总共122例病例中，多数来自3个地区（纽约，新泽西和伊利诺伊）的医疗机构。多数患者罹患慢性疾病，在急性疾病护理机构长期住院（如接受机械通气）。
The heightened attention to the emergence of C auris infections in healthcare facilities reflects the fact that the fungus is often multidrug resistant and has an associated mortality rate of 60%. CDC analysis of the first 35 clinical isolates showed that 86% were resistant to fluconazole, 43% were resistant to amphotericin B, and 3% were resistant to echinocandins.
对于医疗机构中出现耳念珠菌感染的高度关注，系由于真菌常常为多重耐药，相关病死率高达60%。 CDC对于最初35株临床分离株的分析显示，86%对氟康唑耐药，43%对两性霉素B耐药，3%对棘白菌素耐药。
The researchers uncovered epidemiologic links between most of the clinical cases. "In Illinois, three cases were associated with the same long-term care facility. In New York and New Jersey, cases were identified in multiple acute care hospitals, but further investigation found most had overlapping stays at interconnected long-term care facilities and acute care hospitals within a limited geographic area. The case in Massachusetts was linked to the Illinois cases."
研究者发现，多数临床病例之间具有流行病学相关性。“在伊利诺伊州，3个病例来自同一家长期护理机构。在纽约和新泽西，病例来自多家急性病医院，但进一步调查发现，多数病例在有限的地域范围内的长期安养院及急性病医院内有交集。马萨诸塞州的病例与伊利诺伊州的病例相关。“
Screening of 390 close contacts, using a composite swab of the groin and axilla, showed that 12% were colonized by C auris. Testing of patients' rooms also recovered C auris from "mattresses, beds, windowsills, chairs, infusion pumps, and countertops.... C auris was not isolated from rooms after thorough cleaning with a sodium hypochlorite–based disinfectant."
对于390例密切接触者采用腹股沟和腋窝拭子进行筛查，结果发现，12%的患者有耳念珠菌定植。对患者房间的检测也发现，“床垫，床，窗台，椅子，输液泵和工作台...”均能检出耳念珠菌，“采用次氯酸钠消毒剂进行彻底清洗后就检测不到耳念珠菌了。”
On the basis of these findings, the agency now recommends the use of standard and contact precautions for all infected and colonized patients. In addition, patients should be housed in private rooms, and patients' rooms should undergo daily and terminal cleaning "with a disinfectant active against Clostridium difficile spores (an update from previous disinfectant recommendations)." In addition, receiving healthcare facilities should be notified before a patient with C auris colonization or infection is transferred.
基于上述发现，CDC推荐对于所有感染及定植患者采用标准隔离及接触隔离措施。另外，患者应入住隔离房间，并使用“对难辨梭状芽孢杆菌孢子有效的消毒剂（对既往消毒剂推荐意见的更新）”进行房间的每日及终末清洗。另外，在将耳念珠菌定植或感染患者转院前，应当通知接收病患的医疗机构。
Dr Tsay and colleagues note that differences among the C auris isolates from New York, New Jersey, and Illinois indicate multiple introductions of C auris into the United States from South Asia and South America, followed by local transmission.
Tsay博士及其同事表示，纽约、新泽西和伊利诺伊分离的耳念珠菌有所不同，提示来自东亚和南美的耳念珠菌经多种途径进入美国，并发生局部传播。
The authors conclude, "Ongoing investigation of US C auris cases provides epidemiologic and laboratory data suggesting that this fungus can spread within health care facilities and that interventions are needed to prevent transmission during this early stage of C auris emergence."
作者得出结论，“对美国耳念珠菌病例的进一步研究提供了流行病学和实验室数据，这些数据提示，这种真菌能够在医疗机构发生传播，因此需要采取措施进行预防。”
The authors have disclosed no relevant financial relationships.
MMWR Morbid Mortal Wkly Rep. 2017;66:514-515. Full text
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Cite this article: C auris: CDC Warns of Institutional Spread, Updates Guidance - Medscape - May 18, 2017.
上一篇:美国CDC表示，医疗机构的军团菌病广泛流行且致命下一篇:结核分支杆菌的培养
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发表于 2017-6-23 07:54:00
发表于 2017-6-23 07:54:01
