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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High Incidence of Hospital Admissions with Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis among South African Health Care Workers
Annals of Internal Medicine, Volume 153, No. 8, Year 2010
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Description
Background: Nosocomial transmission has been described in extensively drug-resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about the rates of drug-resistant tuberculosis among health care workers in countries with high tuberculosis and HIV burden. Objective: To estimate rates of multidrug-resistant tuberculosis (MDR-TB) and XDR-TB hospitalizations among health care workers in KwaZulu-Natal, South Africa. Design: Retrospective study of patients with drug-resistant tuberculosis who were admitted from 2003 to 2008 for the initiation of drug-resistant tuberculosis therapy. Setting: A public tuberculosis referral hospital in KwaZulu-Natal, South Africa. Participants: 231 health care workers and 4151 non-health care workers admitted for initiation of MDR-TB or XDR-TB treatment. Measurements: Hospital admission rates and hospital admission incidence rate ratios. Results: Estimated incidence of MDR-TB hospitalization was 64.8 per 100 000 health care workers versus 11.9 per 100 000 non-health care workers (incidence rate ratio, 5.46 [95% CI, 4.75 to 6.28]). Estimated incidence of XDR-TB hospitalizations was 7.2 per 100 000 health care workers versus 1.1 per 100 000 non-health care workers (incidence rate ratio, 6.69 [CI, 4.38 to 10.20]). A higher percentage of health care workers than non-health care workers with MDR-TB or XDR-TB were women (78% vs. 47%; P < 0.001), and health care workers were less likely to report previous tuberculosis treatment (41% vs. 92%; P < 0.001). HIV infection did not differ between health care workers and non-health care workers (55% vs. 57%); however, among HIV-infected patients, a higher percentage of health care workers were receiving antiretroviral medications (63% vs. 47%; P < 0.001). Limitation: The study had an observational retrospective design, is subject to referral bias, and had no information on type of health care work or duration of occupational exposure to tuberculosis. Conclusion: Health care workers in this HIV-endemic area were substantially more likely to be hospitalized with either MDR-TB or XDR-TB than were non-health care workers. The increased risk may be explained by occupational exposure, underlining the urgent need for tuberculosis infection-control programs. Primary Funding Source: None. © 2010 American College of Physicians.
Authors & Co-Authors
O'Donnell, Max R.
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Jarand, Julie
Canada, Calgary
University of Calgary
Loveday, Marian
South Africa, Tygerberg
South African Medical Research Council
Padayatchi, Nesri
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Zelnick, Jennifer R.
United States, Salem
Salem State University
Werner, Lise
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Naidoo, Kogieleum L.
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Master, Iqbal M.
Unknown Affiliation
Osburn, G.
Unknown Affiliation
Kvasnovsky, Charlotte Louise
United States, Baltimore
University of Maryland School of Medicine
Shean, Karen P.
South Africa, Observatory
Groote Schuur Hospital
Pai, Madhukar
Unknown Affiliation
van der Walt, Martie L.
South Africa, Pretoria
Tuberculosis Epidemiology and Intervention Research Unit
Horsburgh, Charles Robert
United States, Boston
School of Public Health
Dheda, Keertan U.J.
South Africa, Observatory
Groote Schuur Hospital
Statistics
Citations: 198
Authors: 15
Affiliations: 9
Identifiers
Doi:
10.7326/0003-4819-153-8-201010190-00008
ISSN:
00034819
e-ISSN:
15393704
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa
Participants Gender
Female