Agerton T, Valway S, Gore B, Pozsik C, Plikaytis B, Woodley C, Onorato I
Epidemic Intelligence Service Program, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
JAMA. 1997 Oct 1;278(13):1073-7.
Nosocomial transmission of multidrug-resistant tuberculosis (MDR TB) has been reported primarily in New York State and has generally been presumed to occur via respiratory aerosols.
To assess nosocomial transmission of MDR TB. In 1995, 8 patients with MDR TB were identified in South Carolina; all were resistant to 7 drugs and had matching DNA fingerprints (strain W1). Community linkswere identified for 5 patients (Patients 1-5). However, no links were identified forthe other 3 patients (Patients 6-8) except being hospitalized at the same hospital as 1 community patient.
Outbreak investigation.
Community and hospital.
Eight patients whose MDR TB isolates had DNA fingerprint patterns matching strain W1.
Clinical characteristics of patients with strain W1 Mycobacterium tuberculosis isolates.
Patient 5 (community patient) and Patient 8, diagnosed April 1995 and November 1995, respectively, had clinical courses consistent with MDR TB, with smear-positive and culture-positive specimens and cavitary lesions on chest radiograph; both died of MDR TB less than 1 month after diagnosis. Patients 6 and 7 (diagnosed May 1995) each had 1 positive culture for MDR TB; specimens were collected during bronchoscopy. Patient 6 had a skin test conversion after bronchoscopy. Neither Patient 6 nor Patient 7 had a clinical course consistent with MDR TB, neither was treated for MDR TB, and both are alive and well. No evidence of laboratory contamination of specimens, transmission on inpatient wards, or contact among patients was found. All 4 received bronchoscopies in May 1995; Patients 6, 7, and 8 had bronchoscopies 1, 12, and 17 days, respectively, after Patient 5. Observations revealed that bronchoscope cleaning was inadequate, and the bronchoscope was never immersed in disinfectant.
Inadequate cleaning and disinfection of the bronchoscope after the procedure performed on Patient 5 led to subsequent false-positive cultures in Patients 6 and 7 and transmission of infection to Patient 6 and active MDR TB to Patient 8.
耐多药结核病（MDR-TB）的医院内传播主要在纽约州有报道，一般认为是通过呼吸道气溶胶传播。
评估耐多药结核病的医院内传播情况。1995年，南卡罗来纳州确诊了8例耐多药结核病患者；所有患者均对7种药物耐药，且DNA指纹图谱匹配（菌株W1）。确定了5例患者（患者1 - 5）的社区传播链。然而，另外3例患者（患者6 - 8）除了与1例社区患者在同一家医院住院外，未发现其他传播链。
暴发调查。
社区和医院。
8例耐多药结核分枝杆菌分离株的DNA指纹图谱与菌株W1匹配的患者。
菌株W1结核分枝杆菌分离株患者的临床特征。
患者5（社区患者）和患者8分别于1995年4月和1995年11月确诊，临床病程符合耐多药结核病，痰涂片阳性、培养阳性，胸部X线片有空洞性病变；两人均在确诊后不到1个月死于耐多药结核病。患者6和患者7（1995年5月确诊）各有1次耐多药结核培养阳性；标本在支气管镜检查期间采集。患者6在支气管镜检查后结核菌素皮肤试验阳转。患者6和患者7的临床病程均不符合耐多药结核病，均未接受耐多药结核病治疗，两人目前均健在且状况良好。未发现标本实验室污染、住院病房传播或患者之间接触的证据。4人于1995年5月均接受了支气管镜检查；患者6、7和8分别在患者5之后1天、12天和17天接受支气管镜检查。观察发现支气管镜清洗不充分，且支气管镜从未浸泡在消毒剂中。
对患者5进行操作后支气管镜清洗和消毒不充分，导致随后患者6和7出现假阳性培养结果，并将感染传播给患者6，将活动性耐多药结核病传播给患者8。
