Quantifying the contribution of smear-negative, culture-positive pulmonary tuberculosis to nosocomial transmission.
Am J Infect Control
; 52(7): 807-812, 2024 07.
Article
em En
| MEDLINE
| ID: mdl-38365178
ABSTRACT
BACKGROUND:
Despite current guidelines for tuberculosis (TB) control in health care settings, which focused on smear-positive cases, prevention of nosocomial TB transmission continues to be a challenge. Here, we report the results of the first hospital-wide prospective study applying interferon-gamma release assay to investigate the role of smear-negative, culture-positive index cases in nosocomial TB transmission.METHODS:
We prospectively identified cases of culture-confirmed smear-negative pulmonary TB receiving aerosol-generating procedures (AGPs) and cases of culture-confirmed smear-positive pulmonary TB admitted at a medical center. Nosocomial transmission was evaluated by screening their close contacts for latent TB infection (LTBI) using an interferon-gamma release assay.RESULTS:
A total of 93 smear-negative index receiving AGP and 122 smear-positive index were enrolled. Among them, 13 (14.0%) and 43 (35.2%) index cases, respectively, had secondary cases of LTBI (P < .001). Sputum smear negativity (adjusted odds ratio 0.20 [0.08-0.48]) and AGP (sputum suction; adjusted odds ratio 3.48 [1.34-9.05]) are independent factors of transmission. A similar proportion in the close contacts of the 2 index groups had LTBI (17 [15.3%] and 63 [16.0%], respectively), and the former index group contributed to 21.3% of the nosocomial transmission.CONCLUSIONS:
Smear-negative, culture-positive index cases receiving AGPs could be as infectious as smear-positive index cases. Hospital TB control policy should also focus on the former group.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Tuberculose Pulmonar
/
Infecção Hospitalar
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article