National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Infect Control Hosp Epidemiol. 2011 Sep;32(9):837-44. doi: 10.1086/661282.
Healthcare-associated outbreaks and pseudo-outbreaks of rapidly growing mycobacteria (RGM) are frequently associated with contaminated tap water. A pseudo-outbreak of Mycobacterium chelonae-M. abscessus in patients undergoing bronchoscopy was identified by 2 acute care hospitals. RGM was identified in bronchoscopy specimens of 28 patients, 25 of whom resided in the same skilled nursing facility (SNF). An investigation ruled out bronchoscopy procedures, specimen collection, and scope reprocessing at the hospitals as sources of transmission.
To identify the reservoir for RGM within the SNF and evaluate 2 water system treatments, hyperchlorination and point-of-use (POU) membrane filters, to reduce RGM.
A comparative in situ study of 2 water system treatments to prevent RGM transmission.
An SNF specializing in care of patients requiring ventilator support.
RGM and heterotrophic plate count (HPC) bacteria were examined in facility water before and after hyperchlorination and in a subsequent 24-week assessment of filtered water by colony enumeration on Middlebrook and R2A media.
Mycobacterium chelonae was consistently isolated from the SNF water supply. Hyperchlorination reduced RGM by 1.5 log(10) initially, but the population returned to original levels within 90 days. Concentration of HPC bacteria also decreased temporarily. RGM were reduced below detection level in filtered water, a 3-log(10) reduction. HPC bacteria were not recovered from newly installed filters, although low quantities were found in water from 2-week-old filters.
POU membrane filters may be a feasible prevention measure for healthcare facilities to limit exposure of sensitive individuals to RGM in potable water systems.
与快速生长分枝杆菌（RGM）相关的医疗保健相关暴发和类暴发经常与污染的自来水有关。两家急性护理医院发现分枝杆菌属和脓肿分枝杆菌属在接受支气管镜检查的患者中发生了类暴发。在 28 名患者的支气管镜标本中发现了 RGM，其中 25 名患者居住在同一家熟练护理机构（SNF）中。一项调查排除了支气管镜检查程序、标本采集和医院范围内的内镜再处理是传播源。
确定 SNF 中 RGM 的储库，并评估两种水系统处理方法，即高氯化和即用型（POU）膜过滤器，以减少 RGM。
防止 RGM 传播的两种水系统处理方法的比较原位研究。
一家专门为需要呼吸机支持的患者提供护理的 SNF。
在高氯化前后和随后的 24 周内，通过在 Middlebrook 和 R2A 培养基上进行菌落计数，对设施水中的 RGM 和异养平板计数（HPC）细菌进行检查。
分枝杆菌属 consistently 从 SNF 供水系统中分离出来。高氯化最初将 RGM 减少了 1.5 log(10)，但在 90 天内种群恢复到原始水平。HPC 细菌的浓度也暂时下降。过滤水将 RGM 减少到检测水平以下，降低了 3 log(10)。虽然在两周旧的过滤器中的水中发现了低数量的 HPC 细菌，但在新安装的过滤器中没有回收。
POU 膜过滤器可能是医疗保健设施限制敏感个体在饮用水系统中接触 RGM 的可行预防措施。
