Griffiths P A, Babb J R, Fraise A P
Hospital Infection Research Laboratory, City Hospital NHS Trust, Birmingham, UK.
J Hosp Infect. 1998 Mar;38(3):183-92. doi: 10.1016/s0195-6701(98)90273-0.
The susceptibility of Mycobacterium tuberculosis and Mycobacterium avium-intracellulare to the disinfections used for spillage and heat sensitive instruments has received much attention in recent years. The use of clinical isolates of M. tuberculosis and M. avium-intracellulare as test organisms is considered unsuitable for standard tests due to their hazardous nature (category 3 pathogens and slow growth rates). This has led to much debate in standards committees on the selection and use of a possible surrogate which would be safer and more practical to use and yet mimic the susceptibility of clinical isolates. This study compared the susceptibility of one possible surrogate Mycobacterium terrae NCTC 10856, with that of clinical isolates of M. tuberculosis H37 Rv and M. avium-intracellulare using a quantitative suspension test. The instrument and environmental disinfectants tested were a chlorine-releasing agent, sodium dichloroisocyanyurate (NaDCC) at 1000 ppm and 10,000 ppm av. Cl, chlorine dioxide at 1100 ppm av. ClO2 (Tristel, HayMan MediChem), 0.35% peracetic acid (NuCidex, Johnson & Johnson), 70% industrial methylated spirit (IMS), 2% alkaline glutaraldehyde (Asep, Galen), 10% succine dialdehyde and formaldehyde mixture (Gigasept, Schulke and Mayr). Results showed that the clinical isolate of M. avium-intracellulare was the most resistant of the three test organisms. M. terrae, which is not a category 3 pathogen, was slightly more resistant than M. tuberculosis and this would appear to be a suitable surrogate for establishing tuberculocidal activity. However, with an increase in the clinical significance of M. avium-intracellulare, particularly in human immunodeficiency virus (HIV) and immunocompromised patients, a more resistant surrogate is required. In the absence of such a surrogate, testing with M. avium-intracellulare in a clinical laboratory equipped for handling category 3 pathogens is still advised to establish mycobactericidal activity.
近年来，结核分枝杆菌和鸟分枝杆菌-胞内分枝杆菌对用于处理溢出物及热敏仪器的消毒剂的敏感性备受关注。由于结核分枝杆菌和鸟分枝杆菌-胞内分枝杆菌临床分离株具有危险性（3类病原体且生长速度缓慢），将其用作测试微生物被认为不适用于标准测试。这在标准委员会中引发了诸多关于选择和使用可能替代物的争论，该替代物应更安全、更实用，同时能模拟临床分离株的敏感性。本研究采用定量悬液试验，比较了一种可能的替代物地分枝杆菌NCTC 10856与结核分枝杆菌H37 Rv及鸟分枝杆菌-胞内分枝杆菌临床分离株的敏感性。所测试的仪器和环境消毒剂包括：一种含氯释放剂，有效氯含量为1000 ppm和10000 ppm的二氯异氰尿酸钠（NaDCC）；有效二氧化氯含量为1100 ppm的二氧化氯（Tristel，HayMan MediChem）；0.35%的过氧乙酸（NuCidex，强生公司）；70%的工业甲基化酒精（IMS）；2%的碱性戊二醛（Asep，Galen）；10%的琥珀酸二醛和甲醛混合物（Gigasept，舒尔ke和迈尔公司）。结果表明，鸟分枝杆菌-胞内分枝杆菌临床分离株是三种测试微生物中耐药性最强的。地分枝杆菌不属于3类病原体，其耐药性略高于结核分枝杆菌，这似乎是用于确定杀结核活性的合适替代物。然而，随着鸟分枝杆菌-胞内分枝杆菌临床重要性的增加，尤其是在人类免疫缺陷病毒（HIV）感染和免疫功能低下患者中，需要一种耐药性更强的替代物。在没有这种替代物的情况下，仍建议在配备处理3类病原体设施的临床实验室中使用鸟分枝杆菌-胞内分枝杆菌进行测试，以确定杀分枝杆菌活性。
