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La transmisión de Mycobacterium tuberculosis por un broncoscopio de fibra óptica. Identificación por huellas
T M Michele1, W A Cronin, N M Graham
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2179, USA.
JAMA
|October 7, 1997
Resumen
Un broncoscopio contaminado probablemente transmitió tuberculosis (TB) entre dos pacientes. La tipificación molecular identificó la propagación nosocomial, destacando la necesidad de estrictos protocolos de limpieza del endoscopio para prevenir nuevas infecciones.
Área de la Ciencia:
- Epidemiología de las enfermedades infecciosas Epidemiología de las enfermedades infecciosas
- Microbiología Molecular Microbiología Molecular.
- El control de infecciones hospitalarias para el control de infecciones.
Sus antecedentes:
- Estudio en curso de polimorfismo de longitud de fragmento de restricción (RFLP) de aislamientos de Mycobacterium tuberculosis.
- Se encontraron patrones idénticos de IS6110 RFLP en dos pacientes con tuberculosis diagnosticados con seis meses de diferencia.
- La atención hospitalaria compartida se identificó como el único vínculo entre los dos pacientes.
Objetivo del estudio:
- Investigar la posibilidad de transmisión nosocomal de Mycobacterium tuberculosis entre dos pacientes.
- Identificar la fuente de transmisión e implementar medidas de control.
Principales métodos:
- Realizó una investigación epidemiológica tradicional y molecular.
- Revisó los cuadros médicos, los registros broncoscópicos y las ubicaciones hospitalarias frecuentadas por ambos pacientes.
- Evaluó los sistemas de ventilación hospitalarios y observó los procedimientos de limpieza y desinfección del broncoscopio.
Principales resultados:
- Ambos pacientes se sometieron a broncoscopia con el mismo instrumento en la misma sala de operaciones, sin procedimientos de intervención.
- Se observaron procedimientos inconsistentes de limpieza y desinfección del broncoscopio, que se desvían de las directrices nacionales.
- La tuberculosis por Mycobacterium se identificó en el segundo paciente después de la broncoscopia, con patrones de RFLP idénticos a los del primer paciente.
Conclusiones:
- Un broncoscopio contaminado fue identificado como la fuente más probable de transmisión de Mycobacterium tuberculosis entre los dos pacientes.
- El análisis del polimorfismo de la longitud del fragmento de restricción (RFLP) fue crucial para detectar esta transmisión nosocomial.
- Los hallazgos subrayan la importancia crítica de adherirse a los estrictos protocolos de limpieza y desinfección del endoscopio para prevenir las infecciones asociadas a la atención médica.
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