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MDR-TB in South African Health Care Workers
By Carol A. Kemper, MD, FACP
This article originally appeared in the March issue of Infectious Disease Alert.
Source: O'Donnel MR, et al. High incidence of hospital admissions with multi-drug resistant and extensively drug-resistant tuberculosis among South African healthcare workers. Ann Intern Med 2010;153:516-522.
Admissions to a public hospital in kwazulu-natal, South Africa, for treatment of MDR- and XDR-TB from 2003 to 2008 were examined for health care workers (HCWs) compared with non-HCWs.
During this time, 4,151 non-HCWs and 231 HCWs (≥ age 20) with MDR-TB or XDR-TB were admitted. The number of admissions for MDR-TB increased from 440 to 1,028 cases (43 HCWs) and the number of admissions for XDR-TB increased from 6 to 114 cases (12 HCWs). The mean age and HIV status (55% of HCWs vs. 57% of non-HCWs were HIV+) of the two groups were similar, although more of the HIV+ HCWs were receiving antiretroviral therapy.
The estimated incidence of MDR-TB in HCWs admitted to hospital was 64.8/100,000 vs. 11.9/100,000 in non-HCWs; the incidence of XDR-TB in HCWs was 7.2/100,000 vs. 1.1/100,000 in non-HCWs. A key finding was that HCWs were significantly less likely to have received prior TB treatment than non-HCWs (41% vs. 92%; P < 0.0001), suggesting that while resistance may be acquired in non-HCWs as the result of inadequate treatment or non-compliance, HCWs were more likely to acquire organisms already drug-resistant.
Nosocomial transmission of TB respresents a significant threat to HCWs; good airborne transmission precautions and appropriate facilities are essential. Not only are trained HCWs too valuable an asset for these countries to lose, but HCWs infected with TB also present a safety risk to patients. A greater percentage of the HCWs with resistant TB in this study compared with non-HCWs were women (78% vs. 47%), suggesting that women were more likely involved in direct patient care and, therefore, at greater risk for exposure.