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1、近期软式内镜(ERCP)相关的多重耐药菌感染暴发及对策解放军总医院感染管理与疾病控制科刘运喜主要内容一、软式内镜相关感染暴发（一）软式内镜导致的相关感染1.胃肠镜孔道HBVDNA污染的现场调查ContaminationwithhepatitisBvirusDNAingastrointestinalendoscopechannels:riskofinfectiononreuseafteron-sitecleaning.IshinoY,IdoK,SuganoK.Dept.ofGastroenterology,JichiMe
2、dicalSchool,Tochigi,Japan.ishino@jichi.ac.jpMATERIALSANDMETHODS:Afterendoscopicexaminations,includingbiopsyprocedures,in17patientswhowerepositiveforhepatitisBvirussurfaceantigenandeightpatientswhowerepositiveforhepatitisC（17例HBV阳性，其中8人HCV阳性）virusantibody,theendo
3、scopeswerecleanedonsitebysuctioningandflushingtheairandwaterchannelswithanenzymedetergent.Firstsampleswerethencollectedbyflushing5mlofsterilewaterthrougheachchannel.Aftermechanicalreprocessing,secondsampleswerecollectedinthesameway.Virologicalstudieswerecarriedo
4、utwithreal-timepolymerasechainreactionsforhepatitisBvirusDNAandhepatitisCvirusRNA（实时荧光PCR).RESULTS:HepatitisBvirusDNAwasdetectedinfiveofthefirstsamplesrecoveredfromthesuction/accessorychannels5份来自标本吸引/活检管路（++）oftheendoscopes(titersof1.3x10(4)to2.5x10(5)copies/ml
5、),whilenocontaminationwasdetectedafterreprocessing(P=0.0445).Thefirstsamplesfromonewaterchannelandthreeairchannels1份来自送水管道和3份来自送气管道（++）werealsopositiveforhepatitisBvirusDNA,butwerenegativeafterreprocessing清洗消毒处理后采样(—)(P>0.5,P=0.227,respectively).NohepatitisCviru
6、sRNAwasdetectedinanyofthesamples（HCV阴性）.CONCLUSIONS:Theseresultsindicatethatallofthechannelswerepotentialsourcesofviralinfection所用管道都是病毒感染的潜在来源.Endoscopy.2005Jun;37(6):548-51.1.胃肠镜孔道HBVDNA污染的现场调查17patientswhowerepositiveforhepatitisB现场处理后采样(++)531清洗消毒处理后采样(—)End
7、oscopy.2005Jun;37(6):548-51.2.由于缺乏测漏试验导致的支气管镜检查相关的结核分枝杆菌感染暴发Results:DuringJuly1999,19bronchoscopicprocedureswereperformedin19patients.Bronchialwashingspecimensformycobacterialculturewereobtainedfrom18patients.Tencaseswereidentified.19个病人使用支气管镜，从获得的18份病人支气管灌洗液标本中
8、检测结核分枝杆菌，10份阳性。Twocasepatients,includingtheindexpatient,hadsignsandsymptomsofactivetuberculosispriortobronchoscopy.2个病人包括指示病例做支气管镜检查前有活动性结核症状。Mtuberculosisinfectionsd
