Department of Bacteriology, Northern Ireland Public Health Laboratory, Belfast City Hospital, Belfast; School of Biomedical Sciences, Ulster University, Coleraine; School of Medicine, Dentistry and Biomedical Science, The Wellcome.Wolfson Institute for Experimental Medicine, Queenfs University, Belfast, Northern Ireland.
Int J Mycobacteriol. 2020 Apr-Jun;9(2):173-175. doi: 10.4103/ijmy.ijmy_62_20.
Nebulizer hygiene and care is important in cystic fibrosis (CF) to minimize device contamination from bacteria, including nontuberculous mycobacteria (NTMs). Most nebulizer manufacturers recommend nebulizer drying, however there is little evidence to understand how nebulizer drying affects NTM survival.
Mycobacterium abscessus subsp. massiliense (n = 2), M. abscessus subsp. bolletii (n = 2), and M. abscessus subsp. abscessus (n = 2) were evaluated for their ability to survive simulated drying conditions associated with routine nebulizer care. Bacterial inocula (circa. 10 colony-forming units) were added to plastic and allowed to dry to completeness for 24 h, employing passive and active drying.
NTM isolates of all subspecies could be recovered from all passive and active drying experiments, both in diluent and in sterile sputum, following drying (24 h). There was no combination of drying or physiology that supported NTM cell death, and there was no difference in observed survival with the three species of M. abscessus examined.
This study indicates that drying, either passively or actively, for 24 h at room temperature, is unable to eradicate all M. abscessus organisms from dry plastic surfaces, even in the presence of residual sputum contamination. Whilst drying may be advantageous for nebulizer performance, it should not be regarded as an absolute control for the elimination of NTM organisms. With nebulizer hygiene, NTM organisms would be able to survive on a nebulizer following drying for 24 h, which has not undergone any formal disinfection protocol. Therefore, for NTM eradication from washed nebulizers, CF patients should therefore seek an effective alternative control to drying for NTM eradication, i.e., heat disinfection in baby bottle disinfectors. CF patients and health-care professionals should not rely solely on nebulizer drying to achieve NTM eradication.
在囊性纤维化 (CF) 中，雾化器的卫生和护理很重要，以最大程度地减少来自细菌（包括非结核分枝杆菌 [NTM]）的设备污染。大多数雾化器制造商都建议对雾化器进行干燥，但几乎没有证据表明了解雾化器干燥如何影响 NTM 的生存能力。
评估了脓肿分枝杆菌亚种。马萨诸塞（n = 2）、脓肿分枝杆菌亚种。bolletii（n = 2）和脓肿分枝杆菌亚种。脓肿（n = 2）模拟与常规雾化器护理相关的干燥条件下的生存能力。将细菌接种物（约 10 个菌落形成单位）添加到塑料中，并在 24 小时内进行被动和主动干燥，直至完全干燥。
在干燥后（24 小时），在稀释剂和无菌痰液中，从所有被动和主动干燥实验中都可以从所有亚种的 NTM 分离株中回收，无论是在稀释剂中还是在无菌痰液中。没有一种干燥或生理组合支持 NTM 细胞死亡，并且在所检查的三种脓肿分枝杆菌中，观察到的存活情况没有差异。
本研究表明，在室温下被动或主动干燥 24 小时，无法从干燥的塑料表面彻底清除所有脓肿分枝杆菌，即使存在残留痰液污染也是如此。虽然干燥可能有利于雾化器的性能，但不应将其视为消除 NTM 生物体的绝对控制手段。在雾化器卫生方面，即使经过任何正式的消毒程序，在干燥后 24 小时内，NTM 生物体仍将能够在雾化器上存活。因此，对于从已清洗的雾化器中根除 NTM，CF 患者应寻求有效的替代控制方法，而不是干燥，即婴儿奶瓶消毒器中的热消毒。CF 患者和医务人员不应仅依靠雾化器干燥来实现 NTM 根除。
