French A L, Welbel S F, Dietrich S E, Mosher L B, Breall P S, Paul W S, Kocka F E, Weinstein R A
Cook County Hospital, Rush Medical College, Chicago, Illinois 60612, USA.
Ann Intern Med. 1998 Dec 1;129(11):856-61. doi: 10.7326/0003-4819-129-11_part_1-199812010-00003.
DNA fingerprinting establishes the genetic relatedness of Mycobacterium tuberculosis isolates and has become a powerful tool in tuberculosis epidemiology.
To use DNA fingerprinting to assess the efficacy of current tuberculosis infection-control practices.
Retrospective molecular and descriptive epidemiologic study.
A 700-bed urban public hospital that follows the Centers for Disease Control and Prevention (CDC) guidelines for tuberculosis infection control.
183 patients who had positive cultures for M. tuberculosis from 1 April 1995 to 31 March 1996.
173 of 183 M. tuberculosis isolates from the study period underwent DNA fingerprinting. Fingerprinting revealed that five isolates represented false-positive cultures and that 91 (54%) of the remaining 168 isolates were in 15 DNA fingerprinting clusters, which ranged in size from 2 to 29 isolates. Risk factors for clustering were birth in the United States, African-American ethnicity, homelessness, substance abuse, and male sex. Retrospective epidemiologic analysis of inpatient and outpatient visits by the 91 patients who had clustered isolates revealed only one possible instance of patient-to-patient transmission.
The DNA fingerprinting of all M. tuberculosis isolates from a 1-year period revealed one possible instance of nosocomial transmission and five false-positive M. tuberculosis cultures. However, these results did not lead to changes in infection-control practices or in clinical care. The study findings do not support the use of DNA fingerprinting for nosocomial tuberculosis surveillance, but they suggest that compliance with the CDC tuberculosis infection-control guidelines may control patient-to-patient transmission in high-risk urban hospitals.
DNA指纹图谱技术可确定结核分枝杆菌分离株之间的遗传相关性，已成为结核病流行病学研究中的一项有力工具。
运用DNA指纹图谱技术评估当前结核病感染控制措施的效果。
回顾性分子及描述性流行病学研究。
一家拥有700张床位的城市公立医院，该医院遵循美国疾病控制与预防中心（CDC）的结核病感染控制指南。
1995年4月1日至1996年3月31日期间痰培养结核分枝杆菌呈阳性的183例患者。
研究期间分离出的183株结核分枝杆菌中，173株进行了DNA指纹图谱分析。指纹图谱分析显示，有5株分离株代表假阳性培养结果，其余168株分离株中有91株（54%）属于15个DNA指纹图谱聚类，聚类大小从2株到29株不等。聚类的危险因素包括在美国出生、非裔美国人种族、无家可归、药物滥用和男性。对91例分离株聚类患者的住院和门诊就诊情况进行回顾性流行病学分析，仅发现1例可能的患者间传播情况。
对1年期间所有结核分枝杆菌分离株进行DNA指纹图谱分析，发现1例可能的医院内传播情况以及5例假阳性结核分枝杆菌培养结果。然而，这些结果并未导致感染控制措施或临床护理的改变。研究结果不支持将DNA指纹图谱技术用于医院内结核病监测，但表明遵守CDC结核病感染控制指南可能有助于控制高危城市医院内的患者间传播。
