Sood Geeta, Parrish Nikki
aDivision of Infectious Diseases, Department of Medicine bDivision of Medical Microbiology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Curr Opin Infect Dis. 2017 Aug;30(4):404-409. doi: 10.1097/QCO.0000000000000386.
The purpose of this review is to summarize the emerging literature on nontuberculous mycobacteria outbreaks in healthcare settings. As our ability to identify mycobacterial species develops, we are better able to recognize epidemiologic connections and better understand the prevalence and importance of these outbreaks and pseudo-outbreaks in healthcare settings.
The number of outbreaks related to nontuberculous outbreaks is increasing because of heightened awareness and better diagnostic tests for species level identification of mycobacteria. Outbreaks in healthcare settings have been related to cardiac surgery, plastic surgery, including medical tourism, colonized humidifiers and heater-cooler devices, imperfect disinfection, and hospital water sources. Mycobacteria have a predilection to form biofilms, are resistant to disinfection and are prevalent in hospital water systems. Patients with structural lung disease like cystic fibrosis patients are at particularly high risk for mycobacterial infection. It has been thought that acquisition in this patient population is from common environmental exposure; however, there is increasing evidence that transmission in this patient population can occur through either direct or indirect patient-to-patient spread.
Mycobacteria outbreaks in healthcare settings have been underrecognized. As we identify additional clusters of infection with better diagnostic tools and heightened awareness, we will likely need better infection control practices to prevent infections in healthcare settings.
本综述旨在总结医疗环境中非结核分枝杆菌暴发的最新文献。随着我们识别分枝杆菌种类能力的发展，我们能够更好地识别流行病学关联，并更好地了解这些暴发及假暴发在医疗环境中的发生率和重要性。
由于对分枝杆菌进行菌种水平鉴定的认识提高和诊断测试改进，与非结核分枝杆菌暴发相关的事件数量正在增加。医疗环境中的暴发与心脏手术、整形手术（包括医疗旅游）、被定植的加湿器和热交换水箱装置、消毒不完善以及医院水源有关。分枝杆菌倾向于形成生物膜，对消毒有抗性，且在医院水系统中普遍存在。患有结构性肺病的患者（如囊性纤维化患者）感染分枝杆菌的风险特别高。过去认为该患者群体的感染源自常见的环境暴露；然而，越来越多的证据表明，该患者群体中的传播可通过患者之间的直接或间接传播发生。
医疗环境中的分枝杆菌暴发一直未得到充分认识。随着我们通过更好的诊断工具和提高认识识别出更多感染集群，我们可能需要更好的感染控制措施来预防医疗环境中的感染。
