Li Trudy, Abebe Lydia S, Cronk Ryan, Bartram Jamie
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC, 27599, USA.
Int J Hyg Environ Health. 2017 May;220(3):611-620. doi: 10.1016/j.ijheh.2016.12.002. Epub 2016 Dec 19.
Healthcare-acquired infections are an increasing problem for health care providers and policy makers. Water is an overlooked source of infectious microorganisms in health care facilities. Waterborne nontuberculous mycobacteria (NTM) are ubiquitous, and particularly problematic in health care facility water systems, and cause a variety of diseases. The purpose of this review is to assess health care associated NTM infections from health care facility water systems. We documented susceptible populations, modes of transmission, and the median attack rate (e.g. patients infected per patients exposed). We aimed to identify transmission risk factors and inform evidence-based policies for infection control and prevention. We searched Embase, PubMed, Web of Science and clinicaltrials.gov without date restrictions. English language articles with original data on NTM waterborne infections in health care settings were included. Randomized controlled trials, descriptive studies (case reports, case series), case-control studies, cohort studies, cross-sectional surveys, and quasi-experimental studies on nosocomial waterborne infections were included. Three investigators independently screened titles and abstracts for relevant articles, and one screened full-text articles. Data were extracted by one investigator, and a second confirmed accuracy for 10% of results. We included 22 observational studies. Immunocompromised, post-surgical, and hemodialysis patients were commonly affected populations. A range of exposure routes such as uncovered central venous catheters (CVCs), wound exposure, and contamination during surgical procedures was reported. The median attack rate was 12.1% (interquartile range, 11-27.2). Waterborne NTM infection affects susceptible patients through common, preventable exposure routes. Effective prevention strategies will require both medical and environmental health expertise, and inter-professional cooperation will optimize these efforts.
医疗保健机构获得性感染对于医疗服务提供者和政策制定者而言，正成为一个日益严重的问题。水是医疗保健机构中被忽视的感染性微生物来源。水源性非结核分枝杆菌（NTM）广泛存在，在医疗保健机构的水系统中尤其成问题，并会引发多种疾病。本综述的目的是评估医疗保健机构水系统中与医疗保健相关的NTM感染情况。我们记录了易感人群、传播方式以及中位发病率（例如，每例暴露患者中感染的患者数）。我们旨在确定传播风险因素，并为感染控制和预防提供循证政策依据。我们检索了Embase、PubMed、科学引文索引和ClinicalTrials.gov，无日期限制。纳入了有关医疗保健环境中NTM水源性感染原始数据的英文文章。纳入了关于医院水源性感染的随机对照试验、描述性研究（病例报告、病例系列）、病例对照研究、队列研究、横断面调查和准实验研究。三名研究人员独立筛选标题和摘要以查找相关文章，一名研究人员筛选全文文章。由一名研究人员提取数据，另一名研究人员对10%的结果进行准确性确认。我们纳入了22项观察性研究。免疫功能低下、术后和血液透析患者是常见的受影响人群。报告了一系列暴露途径，如未覆盖的中心静脉导管（CVC）、伤口暴露以及手术过程中的污染。中位发病率为12.1%（四分位间距，11 - 27.2）。水源性NTM感染通过常见的、可预防的暴露途径影响易感患者。有效的预防策略将需要医学和环境卫生专业知识，跨专业合作将优化这些努力。
