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Abstract
High incidence of multidrug resistant and extensively drug resistant tuberculosis among South African health care workers
M. O'Donnell1, J. Jarand2, M. Loveday3, N. Padayatchi4, M. Badri5, J. Zelnick6, K. Naidoo4, I. Master7, G. Osburn7, M. Van der Walt3, K. Shean5, C.R. Horsburgh1, K. Dheda5
Background: High mortality has been described in extensively drug resistant tuberculosis (XDR-TB) among HIV-infected patients in South Africa. We present data on multi-drug resistant tuberculosis (MDR-TB) and XDR-TB among health care workers (HCW) referred to a public tuberculosis (TB) hospital in KwaZulu-Natal (KZN), South Africa.
Methods: Eligible patients were referred to King George V Hospital (KGV), KZN between 2003 and 2008; had drug susceptibility testing that met definitions for MDR-TB or XDR-TB. Patients who self-identified as HCW were compared with non-HCW referred to KGV. HCW with MDR-TB were also compared to HCW with XDR-TB. Study data was collected retrospectively and incidence rates were calculated using estimates of HCW in the province during the study period.
Results: 235 HCW were referred to KGV with either MDR-TB (N=211) or XDR-TB (N=24) during the study period. There were 6 deaths (25%) among XDR-TB HCW and 37 deaths (18%) among MDR-TB HCW. 3391 non-HCW with MDR-TB (N=3115) or XDR-TB (N=276) were also referred to KGV between 2003 and 2007. Prevalence of HIV infection did not differ between HCW and non-HCW with drug-resistant TB (48% vs 50% p= 0.58 ). On multivariate analysis HCW were more likely to be female (O.R. 3.33 95% C.I. 2.38-4.76); other factors were not statistical significant. Incidence of MDR-TB was 58.9/100,000 for KZN HCW and 10.7/100,000 for the KZN general population (OR 5.53 95% CI 4.70-6.50). XDR-TB incidence was 4/100,000 among KZN HCW and 1.04/100,000 in the KZN general population (OR 3.89 95% CI 2.02-7.11).
Discussion: HCW in this HIV endemic area appear to be at substantially increased risk for MDR and XDR-TB. This increased risk is likely explained by occupational exposure and not other risk factors. Screening and controlling occupational exposure among HCW is critical to limit nosocomial spread of drug-resistant TB.
* M.O. and J.J. contributed equally to this abstract.
5th IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
TUPEB149
Suggested Citation
"M.O'Donnell, et al.
High incidence of multidrug resistant and extensively drug resistant tuberculosis among South African health care workers .
:
5th IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
TUPEB149 "
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