NOSOCOMIAL TRANSMISSION OF MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS - A RISK TO PATIENTS AND HEALTH-CARE WORKERS
NOSOCOMIAL TRANSMISSION OF MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS - A RISK TO PATIENTS AND HEALTH-CARE WORKERS
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DOI：
10.7326/0003-4819-117-3-191
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发表时间：
1992-08-01
影响因子：
39.2
通讯作者：
JARVIS, WR
中科院分区：
文献类型：
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作者：
PEARSON, ML;JEREB, JA;JARVIS, WR
目的：探讨与耐多药结核病相关的因素，并探讨其可能的医院传播途径。设计：回顾性病例对照研究和结核菌素皮肤试验调查。患者：23例分离株至少对异烟肼和利福平耐药的结核病人(病例)与分离株对所有测试药物敏感的结核病人(对照)进行比较。结果：病例患者更年轻(中位年龄34岁，而不是42岁；P=0.006)，更有可能是艾滋病毒血清阳性(23例中21例，23例患者中11例；优势比11；优势比，11.5；；发病前7个月内入院的可能性较大(优势比为17.1；CI为3.3~97)，尤其是在一个病房(优势比为0，优势比为0.002)。分配到收容病例患者的病房的医护人员比分配到其他病房的医护人员更有可能进行结核病皮试转换(32名医护人员中有11名，而47名医护人员中有1名；P<；0.001)。23例患者中有6例被置于抗酸杆菌隔离环境中，没有被测试的房间有负压。从病例中获得的16株多重耐药菌株中，有14株的限制性片段长度多态性分析具有相同的带型。结论：这些数据表明，耐多药结核病在医院内的传播发生在患者与患者之间以及患者与医护人员之间，并强调了卫生保健机构需要有效的抗酸细菌分离设施，并遵守已公布的感染控制指南。
Objective: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission.Design: A retrospective case-control study and tuberculin skin test survey.Patients: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls). Tuberculin skin test conversion rates were compared among health care workers assigned to wards where patients with tuberculosis were frequently or rarely admitted.Setting: A large, teaching hospital in New York City.Measurements: Mycobacterium tuberculosis isolates from case patients and controls were typed by restriction fragment length polymorphism analysis.Results: Case patients were younger (median age, 34 compared with 42 years; P = 0.006), more likely to be seropositive for HIV (21 of 23 compared with 11 of 23 patients; odds ratio, 11.5; 95% Cl, 1.9 to 117), and more likely to have had a previous hospital admission within 7 months before the onset of tuberculosis (19 of 23 compared with 5 of 23 patients; odds ratio, 17.1; Cl, 3.3 to 97), particularly on one ward (12 of 23 compared with 0 of 23 patients; odds ratio, undefined; P = 0.002). Health care workers assigned to wards housing case patients were more likely to have tuberculin skin test conversions than were health care workers assigned to other wards (11 of 32 compared with 1 of 47 health care workers; P < 0.001). Few (6 of 23) case patients were placed in acid-fast bacilli isolation, and no rooms tested had negative pressure. Of 16 available multidrug-resistant isolates obtained from case patients, 14 had identical banding patterns by restriction fragment length polymorphism analysis. In contrast, M. tuberculosis isolates from controls with drug-susceptible tuberculosis had patterns distinct from each other and from those of case patients.Conclusions: These data suggest nosocomial transmission of multidrug-resistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acid-fast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions.