Larson Janet L, Lambert Lauren, Stricof Rachel L, Driscoll Jeffrey, McGarry Michael A, Ridzon Renée
Surveillance and Epidemiology Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Infect Control Hosp Epidemiol. 2003 Nov;24(11):825-30. doi: 10.1086/502144.
To investigate a possible nosocomial outbreak of tuberculosis (TB).
Retrospective cohort study.
Community hospital.
We reviewed medical records, hospital infection control measures, and potential locations of nosocomial exposure. We examined the results of acid-fast bacilli (AFB) smears, cultures, and drug susceptibility testing, and performed a DNA fingerprint analysis. We observed laboratory specimen processing procedures and bronchoscope disinfection procedures. We also reviewed bronchoscopy records.
In October 2000, three patients had bronchoscopy specimen cultures that were positive for Mycobacterium tuberculosis. Of the three, only one had clinical signs and symptoms consistent with TB and positive AFB sputum smears. The other two did not have signs and symptoms consistent with TB and had no known exposure to individuals with infectious TB. The three M. tuberculosis isolates had matching DNA fingerprints. No evidence of laboratory cross-contamination was identified. The three culture-positive specimens of M. tuberculosis were collected with the same bronchoscope within 9 days. This bronchoscope was inadequately cleaned and disinfected between patients, and the automated reprocessor used was not approved for use with the hospital bronchoscope.
One of the bronchoscopes at this hospital was contaminated with M. tuberculosis during bronchoscopy of an AFB-smear-positive patient. Subsequent specimen contamination likely occurred because the bronchoscope had been inadequately cleaned and disinfected. Patients who subsequently underwent bronchoscopy were also potentially exposed to M. tuberculosis from this bronchoscope.
调查一起可能的医院内结核病暴发。
回顾性队列研究。
社区医院。
我们查阅了病历、医院感染控制措施以及医院内潜在暴露地点。我们检查了抗酸杆菌（AFB）涂片、培养及药敏试验结果，并进行了DNA指纹分析。我们观察了实验室标本处理程序和支气管镜消毒程序。我们还查阅了支气管镜检查记录。
2000年10月，3例患者支气管镜标本培养显示结核分枝杆菌阳性。其中，仅1例有与结核病相符的临床症状及AFB痰涂片阳性。另外2例没有与结核病相符的症状，且无已知的传染性结核病接触史。3株结核分枝杆菌分离株的DNA指纹匹配。未发现实验室交叉污染的证据。3份结核分枝杆菌培养阳性标本在9天内用同一支气管镜采集。该支气管镜在患者之间未得到充分清洁和消毒，且使用的自动处理器未获批准用于该医院支气管镜。
该医院的一台支气管镜在对1例AFB涂片阳性患者进行支气管镜检查时被结核分枝杆菌污染。随后可能因支气管镜未得到充分清洁和消毒而发生标本污染。随后接受支气管镜检查的患者也可能因该支气管镜而接触到结核分枝杆菌。
