Quantifying the contribution of smear-negative, culture-positive pulmonary tuberculosis to nosocomial transmission.

Autor: Yang, Ya-Jen, Pan, Sung-Ching, Lee, Meng-Rui, Chung, Che-Liang, Ku, Chia-Ping, Liao, Chi-Yu, Tsai, Tien-Yu, Wang, Jann-Yuan, Fang, Chi-Tai, Chen, Yee-Chun
Zdroj: American Journal of Infection Control; Jul2024, Vol. 52 Issue 7, p807-812, 6p
Abstrakt: 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. 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. 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. 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. • The role of smear-negative index cases in nosocomial transmission remains unknown. • Smear-negative cases receiving AGPs could be as infectious as smear-positive cases. • Smear-negative cases may be responsible for 21.3% nosocomial TB transmissions. • Ongoing physician education to optimize the utilization of TB-NAAT is imperative. • Hospital TB control should also focus on smear-negative index receiving AGPs. [ABSTRACT FROM AUTHOR]
Databáze: Supplemental Index
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