An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital
An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital
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DOI：
10.1016/s0195-6701(98)90324-3
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发表时间：
1998-06-01
影响因子：
6.9
通讯作者：
French, GL
中科院分区：
文献类型：
--
作者：
Breathnach, AS;de Ruiter, A;French, GL
我们描述了流行病学和控制的医院爆发的多药耐药结核病（MDR-TB）。人类免疫缺陷病毒（HIV）阴性的药物敏感结核患者在无监督治疗期间发展为耐多药结核病。她被送入一个有艾滋病毒阳性患者的病房的隔离室，但医院工作人员不知道的是，该病房相对于主病房处于正压状态。7名艾滋病毒阳性接触者患上耐多药结核病。第二例患者的诊断被推迟，部分原因是他痰中的抗酸杆菌被认为是细胞内鸟分枝杆菌。所有可用的结核分枝杆菌分离株通过分子分型无法区分。对近1400名工作人员和患者接触者进行了筛查，但筛查方案只发现了一例病例。尽管接受了治疗，首位患者和两名接触者仍然死亡。艾滋病毒阳性患者在接触后比其他人更有可能患上结核病，而且病情发展可能更快。在这些患者中，必须始终考虑抗酸杆菌可能代表结核分枝杆菌的可能性。肺结核患者（疑似或证实）不应与免疫抑制患者在同一病房护理，并应进行隔离。耐多药结核病病例必须隔离在负压室中。医院侧房可采用正压消防安全措施；感染控制小组必须了解所有隔离室的气流，在医院建筑设计期间必须征求他们的意见。感染控制小组和临床医生之间的良好沟通很重要，所有医务人员和护理人员都必须了解已确诊或疑似结核病和耐多药结核病患者的管理原则。
We describe the epidemiology and control of a hospital outbreak of multi-drug-resistant tuberculosis (MDR-TB). A human immunodeficiency virus (HIV)-negative patient with drug-sensitive tuberculosis developed MDR-TB during a period of unsupervised therapy. She was admitted to an isolation room in a ward with HIV-positive patients, but the room, unbeknown to hospital staff, was at positive-pressure relative to the main ward. Seven HIV-positive contacts developed MDR-TB. The diagnosis in the second patient was delayed, partly because acid-fast bacilli in his sputum were assumed to be Mycobacterium avium-intracellulare. All the available Mycobacterium tuberculosis isolates were indistinguishable by molecular typing. Nearly 1400 staff and patient contacts were offered screening, but the screening programme detected only one of the cases. Despite therapy, the index patient and two of the contacts died. HIV-positive patients are more likely than others to develop tuberculosis after exposure, and the disease may progress more rapidly. In these patients the possibility that acid-fast bacilli may represent M. tuberculosis must always be considered. Patients with tuberculosis (suspected or proven) should not be nursed in the same wards as immunosuppressed patients, and should be isolated. MDR-TB cases must be isolated in negative-pressure rooms. Hospital siderooms may be positive-pressure as a fire safety measure; infection control teams must be aware of the airflows in all isolation rooms, and must be consulted during the design of hospital buildings. Good communication between infection control teams and clinicians is important, and all medical and nursing staff must be aware of the principles of management of patients with proven or suspected tuberculosis and MDR-TB.