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Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers FREE

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The summary below is from the full report titled “High Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers.” It is in the 19 October 2010 issue of Annals of Internal Medicine (volume 153, pages 516-522). The authors are M.R. O'Donnell, J. Jarand, M. Loveday, N. Padayatchi, J. Zelnick, L. Werner, K. Naidoo, I. Master, G. Osburn, C. Kvasnovsky, K. Shean, M. Pai, M. Van der Walt, C.R. Horsburgh, and K. Dheda.

Ann Intern Med. 2010;153(8):I-62. doi:10.7326/0003-4819-153-8-201010190-00004
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What is the problem and what is known about it so far?

Tuberculosis is a highly infectious disease that may be transmitted if droplets coughed or sneezed by an infected person are breathed in by another person. Outbreaks of tuberculosis have occurred in hospital settings when heath care workers (for example, doctors and nurses) have cared for patients with tuberculosis. The high rate of tuberculosis infection in South Africa is complicated in many patients who have strains of tuberculosis that are resistant to (that is, not effectively treated by) certain antibiotics. Little is known about whether heath care workers in South Africa are at increased risk for acquiring drug-resistant tuberculosis.

Why did the researchers do this particular study?

Learning about the patterns of tuberculous infection may help focus public health efforts to control the disease.

Who was studied?

4382 patients hospitalized to start treatment of drug-resistant tuberculosis.

How was the study done?

Admission records were reviewed at a single hospital that, from 2003 to 2008, was the only institution in a single South African province authorized to start antibiotic treatment for tuberculosis strains that were resistant to either 2 antibiotics (multidrug-resistant tuberculosis [MDR-TB]) or 4 antibiotics (extensively drug-resistant tuberculosis [XDR-TB]). Patients were asked to indicate whether they were heath care workers at the time of hospitalization. The researchers estimated the rates of admission by using public records to indicate the number of health care workers in the province and the size of the general population.

What did the researchers find?

From 2003 to 2008, 231 health care workers and 4151 adult members of the general population (non–health care workers) were hospitalized to start treatment of either MDR-TB or XDR-TB. The estimated rate of admission among health care workers for treatment of MDR-TB was more than 5 times that among non–health care workers. For XDR-TB, the rate for health care workers was more than 6 times that for non–health care workers.

What were the limitations of the study?

The researchers could not be certain that everyone in this South African province infected with tuberculosis during the study period was hospitalized to start treatment, so the estimated rates of hospitalization might not accurately reflect how often health care workers or non–health care workers acquired MDR-TB or XDR-TB. In addition, there was no way to confirm that the patients were or were not health care workers, nor what their actual jobs were.

What are the implications of the study?

Health care workers in South Africa might be at very high risk for acquiring tuberculosis that is resistant to several antibiotics when caring for patients with these infections. These results are worrisome not only for the health of the health care workers themselves but also because of the possible effects of these infections on the availability of noninfected health care workers to care for the general population.





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