Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
Ann Thorac Surg. 2010 Nov;90(5):1425-31. doi: 10.1016/j.athoracsur.2010.06.053.
We report a case of patient-to-surgeon transmission of hepatitis C virus (HCV), and the subsequent transmission of HCV to surgical patients.
In 2007, a cardiac surgeon tested positive for hepatitis C. A complete look-back investigation was initiated that involved screening of all patients on the surgeon's operating lists between September 2004 and April 2007. Genotyping and phylogenetic analyses were performed where HCV RNA was detected.
Of the 499 patients invited to HCV testing, 431 responded, 13 of whom were found anti-HCV positive. One patient, who had surgery in August 2005, was found most likely to be the source of transmission to the surgeon. Of the 270 patients who had surgery after this incident, 10 became infected, giving an estimated rate of transmission of 3.7%. The HCV polymerase chain reaction positive samples were found to be the same genotype 1a strain by phylogenetic analyses. All the 10 subsequently infected patients had undergone open heart surgery, whereas none of the 103 noncardiac patients became infected, giving an estimated risk of transmission during open heart surgery of 6.0% (95% confidence interval [3.3% to 10.7%]).
The transmission rate from an HCV positive surgeon to patients in a cardiothoracic setting was higher than previously reported and significantly higher during open heart surgery compared with vascular and pulmonary surgery. These results indicate the need for unequivocal routines for testing and handling of HCV positive health care workers and patients.
我们报告了一例丙型肝炎病毒（HCV）由患者向外科医生传播，继而传播给外科手术患者的病例。
2007 年，一位心脏外科医生丙型肝炎抗体检测呈阳性。随后展开了全面的回溯性调查，对 2004 年 9 月至 2007 年 4 月期间该外科医生手术名单上的所有患者进行了筛查。对检测到 HCV RNA 的患者进行了基因分型和系统进化分析。
在邀请进行 HCV 检测的 499 名患者中，431 名做出了回应，其中 13 名抗-HCV 阳性。一名于 2005 年 8 月接受手术的患者最有可能是外科医生的传染源。在这一事件之后接受手术的 270 名患者中，有 10 人感染，估计传播率为 3.7%。通过系统进化分析发现，HCV 聚合酶链反应阳性样本为同一种 1a 基因型株。随后感染的 10 名患者均接受了心脏直视手术，而非心脏患者中无一例感染，估计心脏直视手术期间的传播风险为 6.0%（95%置信区间[3.3%至 10.7%]）。
HCV 阳性外科医生向心胸外科患者传播的速度高于既往报道，在心脏直视手术中显著高于血管和肺手术。这些结果表明，需要明确的检测和处理 HCV 阳性医护人员和患者的程序。
