Cleveland J L, Kent J, Gooch B F, Valway S E, Marianos D W, Butler W R, Onorato I M
Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Infect Control Hosp Epidemiol. 1995 Jan;16(1):7-11. doi: 10.1086/646995.
To investigate possible transmission of multidrug-resistant tuberculosis (MDR-TB) in a dental setting.
A retrospective, descriptive study of dental workers (DWs), patients, and practice characteristics.
Two dental workers (DW1 and DW2) with acquired immunodeficiency syndrome and MDR-TB.
A hospital-based (Hospital X) human immunodeficiency virus (HIV) dental clinic in New York City.
To identify dental patients with tuberculosis (TB), patients treated in the dental clinic at Hospital X during 1990 were cross-matched with those listed in the New York City Department of Health Tuberculosis Registry. Mycobacterium tuberculosis isolates from both DWs and from dental patients with TB were tested for antimicrobial susceptibility and typed by restriction fragment length polymorphism (RFLP) analysis. Infection control practices were reviewed.
M tuberculosis isolates infecting DW1 and DW2 were resistant to isoniazid and rifampin and had identical RFLP patterns. DW1 and DW2 worked in close proximity to each other in a small HIV dental clinic in Hospital X during 1990. Of 472 patients treated in the dental clinic in 1990, 41 (8.7%) had culture-proven M tuberculosis infection. Of these 41, 5 had isolates with resistance patterns similar to both DWs; however, for four available isolates, the RFLP patterns were different from the patterns of the DWs. Sixteen of the 41 patients received dental treatment while potentially infectious. Dental patients were not routinely questioned about TB by dental staff, nor were all dental staff screened routinely for TB. No supplemental environmental measures for TB were employed in the dental clinic in 1990.
Our investigation suggests that MDR-TB transmission may have occurred between two DWs in an HIV dental clinic. Opportunities for transmission of TB among dental staff and patients were identified. TB surveillance programs for DWs and appropriate infection control strategies, including worker education, are needed to monitor and minimize exposure to TB in dental settings providing care to patients at risk for TB.
调查牙科环境中耐多药结核病（MDR-TB）的可能传播情况。
对牙科工作人员（DWs）、患者及诊疗特征进行回顾性描述性研究。
两名患有获得性免疫缺陷综合征和耐多药结核病的牙科工作人员（DW1和DW2）。
纽约市一家以医院为基础（X医院）的人类免疫缺陷病毒（HIV）牙科诊所。
为识别患有结核病（TB）的牙科患者，将1990年在X医院牙科诊所接受治疗的患者与纽约市卫生部结核病登记处列出的患者进行交叉比对。对来自DWs和患有结核病的牙科患者的结核分枝杆菌分离株进行药敏试验，并通过限制性片段长度多态性（RFLP）分析进行分型。审查感染控制措施。
感染DW1和DW2的结核分枝杆菌分离株对异烟肼和利福平耐药，且具有相同的RFLP模式。1990年，DW1和DW2在X医院一家小型HIV牙科诊所中彼此相邻工作。1990年在该牙科诊所接受治疗的472名患者中，41名（8.7%）经培养证实感染结核分枝杆菌。在这41名患者中，5名患者的分离株耐药模式与两名DWs相似；然而，对于4株可用的分离株，其RFLP模式与DWs的模式不同。41名患者中有16名在具有潜在传染性时接受了牙科治疗。牙科工作人员未对牙科患者常规询问结核病情况，也未对所有牙科工作人员常规进行结核病筛查。1990年该牙科诊所未采取针对结核病的补充环境措施。
我们的调查表明，耐多药结核病可能在一家HIV牙科诊所的两名DWs之间发生了传播。确定了牙科工作人员和患者之间结核病传播的机会。需要针对DWs的结核病监测计划以及包括工作人员教育在内的适当感染控制策略，以监测并尽量减少在为有结核病风险患者提供护理的牙科环境中接触结核病的情况。
