百日咳院內感染的分子生物學調查

Investigation of Nosocomial Pertussis Outbreak

洪國禎(Kuo-Chen Hung) ； 林曉娟(Hsiao-Chuan Lin) ； 王任賢(Jen-Hsien Wang) ； 莊麗玲(Li-Ling Chuan) ； 邱乾順(Chien-Shun Chiou)

《感染控制雜誌》 14卷4期 (2004/08) Pp. 223-229

https://doi.org/10.6526/ICJ.200408_14(4).0003

摘要

中部某醫學中心，在民國91年12月7日有一名3個月大的男嬰，因急遽咳嗽合併發紺而入院，經診斷為疑似百日咳個案，給予紅黴素治療，於該月14日出院。另一4個月大的女嬰在91年12月6日因蜂窩性組織炎住院治療，該月12日出院後，自同月31日起持續嚴重咳嗽3個禮拜，陪同照顧的母親也有陣發性咳嗽的表現，因同一病房、相鄰病床、住院時間重疊的關聯性，疑似院內感染，由感染管制小組調查，執行必要的隔離措施。微生物學檢驗從男嬰母親與伯母及女嬰分離出百日咳桿菌，並進行菌株之脈衝式電泳分子分型，結果顯示三者的百日咳菌株基因圖譜相同，推測此為一起院內感染事件。此事件的發生，在於懷疑男嬰患有百日咳之虞時，未能將其隔離，而傳染同病房之女嬰。在女嬰再次入院治療時，醫護人員採取呼吸道隔離措施，並將女嬰隔離至單一病房、投藥治療後，未再發生其它感染事件。

關鍵字

百日咳 ； 院內感染

並列摘要

Pertussis is a highly contagious respiratory tract infection. It is transmitted by the route of aerosol or droplets at close range. A 3-month old male infant was admitted to a teaching hospital in central Taiwan on December 7, 2002, with the chief complaint of severe cough with cyanosis for two weeks prior to admission. The infant had not been given DPT vaccination. Under the impression of pertussis, erythromycin was prescribed. In the same room, there was a 4-month old female infant who had been hospitalized on December 6 as a result of cellulites, and was discharged on December 12. The first dose of DPT had been given one month prior to her admission. She started to have severe cough since December 31 that lasted for 3 weeks, and was admitted again. Her mother who cared for the baby in the hospital also had the paroxysmal cough about the same time. Because of the overlap in the hospital stay and in the same room with the index case, nosocomial pertussis was suspected. An investigation and all measures for infection control were initiated. Throat swab for cultures were obtained from all 8 family members of both infants. B. pertussis was isolated from the female infant and the mother and the aunt of the male infant. Pulse field gel electrophoresis was performed. The DNA fingerprints were nearly identical among the 3 isolates. The diagnosis of nosocomial pertussis was made. This infection could have been prevented if the index case had been isolated from the female infant and from his family. After the use of erythromycin, and respiratory isolation procedures for the female patient on the second hospitalization, there was no new case with pertussis-like symptoms.

並列關鍵字

pertussis ； nosocomial infection