Michele T M, Cronin W A, Graham N M, Dwyer D M, Pope D S, Harrington S, Chaisson R E, Bishai W R
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2179, USA.
JAMA. 1997 Oct 1;278(13):1093-5.
An ongoing restriction fragment length polymorphism (RFLP) study of Mycobacterium tuberculosis isolates from tuberculosis (TB) cases revealed an identical 10-banded IS6110 RFLP pattern unique to 2 patients diagnosed as having TB 6 months apart. Their only identifiable link was care at the same hospital.
To determine if nosocomial transmission had occurred.
Traditional and molecular epidemiologic investigation.
We reviewed medical charts and bronchoscopic records, examined hospital locations visited by both patients, evaluated hospital ventilation systems, and observed cleaning and disinfection of bronchoscopes.
A patient with cough, hoarseness, and fever underwent bronchoscopy and was diagnosed as having TB. A second patient with a mediastinal mass underwent bronchoscopy 2 days later and was diagnosed as having small cell carcinoma. Following 6 months of chemotherapy and radiation therapy, the second patient developed fever and an infiltrate of the right upper lobe of the lung. Bronchoscopic washings revealed acid-fast bacilli and were culture positive for M tuberculosis. Both patients had undergone bronchoscopy with the same instrument in the same operating room with no intervening bronchoscopies. Bronchoscope cleaning and disinfection procedures were inconsistent with national guidelines.
A contaminated bronchoscope was the most likely source of M tuberculosis transmission between these 2 patients. The RFLP analysis of M tuberculosis isolates was responsible for detecting this nosocomial source of transmission and led to the implementation of public health measures to prevent further spread of infection and disease. This study emphasizes the need for continued vigilance in endoscope cleaning techniques.
一项正在进行的对肺结核（TB）病例中结核分枝杆菌分离株的限制性片段长度多态性（RFLP）研究显示，两名间隔6个月被诊断为患有结核病的患者具有相同的独特的10条带IS6110 RFLP模式。他们唯一可识别的联系是在同一家医院接受治疗。
确定是否发生了医院内传播。
传统和分子流行病学调查。
我们查阅了病历和支气管镜检查记录，检查了两名患者去过的医院地点，评估了医院通风系统，并观察了支气管镜的清洁和消毒情况。
一名咳嗽、声音嘶哑和发热的患者接受了支气管镜检查，被诊断为患有结核病。第二名患有纵隔肿块的患者在两天后接受了支气管镜检查，被诊断为患有小细胞癌。在进行了6个月的化疗和放疗后，第二名患者出现发热和右肺上叶浸润。支气管镜冲洗液显示抗酸杆菌，结核分枝杆菌培养呈阳性。两名患者在同一手术室使用同一台仪器进行了支气管镜检查，期间没有其他支气管镜检查。支气管镜的清洁和消毒程序不符合国家指南。
受污染的支气管镜是这两名患者之间结核分枝杆菌传播的最可能来源。结核分枝杆菌分离株的RFLP分析负责检测到这种医院内传播来源，并导致实施公共卫生措施以防止感染和疾病的进一步传播。本研究强调了在内窥镜清洁技术方面持续保持警惕的必要性。
