ATS 2009 · San Diego
International Conference
Abstract Category: 11.02 - Epidemiology of Tuberculosis
I confirm that all authors listed on this abstract have knowledge of the abstract submission: Yes
Title: Extensively Drug-Resistant Tuberculosis
A Threat to Health Care WorkersJ. M. Jarand, MD1, M. Loveday, MPhil2, K. Shean, RN3, P. Willcox, MD3 and K. Dheda, MD3. 1University of Calgary, Calgary, AB, Canada; 2Medical Research Council, Cape Town, Western Cape, South Africa and 3University of Cape Town, Cape Town, Western Cape, South Africa.
RATIONALE: Extensively drug resistant tuberculosis (XDRTB) has added significant strain to already overwhelmed TB control programs in high burden areas. This strain is further exacerbated by a global shortage of health care workers (HCWs) which has reached crisis levels in parts of sub-Saharan Africa. TB is a well-recognized occupational risk for HCWs in both low and high income countries but the prevalence of XDRTB in HCWs is unknown.
METHODS: Retrospective chart review. Among 317 passively detected XDRTB cases in South Africa, 11 HCWs were identified and described as, to the best of our knowledge, the first series of HCWs with XDR TB in a non-outbreak setting.
RESULTS: Patients were young (mean age 36 years), predominantly female (91%) non-smokers (100%), nurses (72%) working primarily in district hospitals. Eight of the eleven patients were HIV negative. Ten patients had been treated for TB on at least one previous occasion. At the time they were diagnosed with XDRTB, there were no standard infection control measures in place at the facilities where these HCWs worked. The median duration from first multidrug-resistant TB (MDRTB) sputum to XDRTB sputum culture was 19 months. The mean delay in treatment of MDR or XDRTB was 4 months. All patients were treated with multidrug anti-tuberculous therapy with one patient undergoing adjunctive surgery.
CONCLUSIONS: XDRTB is an important risk for HCWs globally, particularly for those who work and/or travel to high burden areas, regardless of HIV status. Implementation of infection control measures and rapid diagnostic testing for all HCWs suspected of TB needs to be undertaken urgently to minimize the risk of drug-resistant TB.