Wenger P N, Otten J, Breeden A, Orfas D, Beck-Sague C M, Jarvis W R
Hospital Infections Program, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Lancet. 1995 Jan 28;345(8944):235-40. doi: 10.1016/s0140-6736(95)90228-7.
From 1988 to 1990, an outbreak of multidrug-resistant tuberculosis (MDR-TB) among patients, and an increased number of tuberculin-skin-test conversions among healthcare workers, occurred on the HIV ward of Jackson Memorial Hospital, Miami, Florida, USA. Measures similar to those subsequently recommended in the 1990 Centers for Disease Control and Prevention guidelines were implemented on the HIV ward by June, 1990, and in September, 1992, we evaluated the efficacy of these control measures. Among MDR-TB patients and healthcare workers with tuberculin-skin-test conversions on the HIV ward, we looked for evidence of exposure to HIV ward MDR-TB patients positive for acid-fast bacilli in sputum during initial (January-May, 1990) and follow-up (June, 1990-June, 1992) periods. Exposure before implementation of control measures to an infectious MDR-TB patient on the HIV ward was recorded in 12 of 15 (80%) MDR-TB patients during the initial period and 5 of 11 (45%) MDR-TB patients during follow-up. After implementation of control measures, no episodes of MDR-TB could be traced to contact with infectious MDR-TB patients on the HIV ward. Skin-test conversions among workers on the HIV ward declined from 7 of 25 (28%) during the initial period to 3 of 17 (18%) in the early (June, 1990-February, 1991) and 0 of 23 in the late (March, 1991-June, 1992) follow-up periods (p < 0.01). Skin-test conversions among healthcare workers were not associated with increased exposure to MDR-TB patients, and were not significantly higher among workers on the HIV ward than on a control ward without tuberculosis patients (3/27 vs 0/16). These data demonstrate that implementation of measures similar to the Centers for Disease Control and Prevention 1990 tuberculosis-control guidelines were effective in halting transmission of MDR-TB to healthcare workers and HIV-infected patients.
1988年至1990年期间，美国佛罗里达州迈阿密市杰克逊纪念医院的艾滋病病房发生了多药耐药结核病（MDR-TB）患者疫情，医护人员结核菌素皮肤试验阳转人数也有所增加。1990年6月前，艾滋病病房实施了与1990年美国疾病控制与预防中心指南随后推荐措施类似的措施。1992年9月，我们评估了这些控制措施的效果。在艾滋病病房的耐多药结核病患者和结核菌素皮肤试验阳转的医护人员中，我们寻找在初始阶段（1990年1月至5月）和随访阶段（1990年6月至1992年6月）接触痰中抗酸杆菌阳性的艾滋病病房耐多药结核病患者的证据。在初始阶段，15例耐多药结核病患者中有12例（80%）记录了在控制措施实施前接触艾滋病病房传染性耐多药结核病患者的情况，随访阶段11例耐多药结核病患者中有5例（45%）。实施控制措施后，未发现耐多药结核病病例可追溯到与艾滋病病房传染性耐多药结核病患者的接触。艾滋病病房工作人员的皮肤试验阳转率从初始阶段的25例中的7例（28%）降至早期（1990年6月至1991年2月）的17例中的3例（18%），后期（1991年3月至1992年6月）的23例中的0例（p<0.01）。医护人员的皮肤试验阳转与接触耐多药结核病患者增加无关，艾滋病病房工作人员的皮肤试验阳转率并不显著高于无结核病患者的对照病房（27例中的3例 vs 16例中的0例）。这些数据表明，实施与美国疾病控制与预防中心1990年结核病控制指南类似的措施可有效阻止耐多药结核病向医护人员和艾滋病感染患者的传播。
