Dooley S W, Villarino M E, Lawrence M, Salinas L, Amil S, Rullan J V, Jarvis W R, Bloch A B, Cauthen G M
Division of Tuberculosis Elimination, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1992 May 20;267(19):2632-4.
To assess nosocomial transmission of tuberculosis (TB).
A historical cohort study of hospitalized patients with the human immunodeficiency virus (HIV) and a purified protein derivative (PPD) tuberculin skin test survey of health care workers (HCWs).
A large public teaching hospital in San Juan, Puerto Rico.
For the cohort study, a case patient was defined as any patient in the HIV unit at the hospital who developed culture-positive TB from 31 days or more after admission through December 31, 1989. For the PPD survey, of 1420 HCWs from the hospital, 908 agreed to participate and had sufficient data for analysis.
For the cohort study, to compare the risk of developing active TB among patients who were exposed to hospital roommates with infectious TB and the risk among nonexposed patients. For the HCW PPD survey, to determine the prevalence of and risk factors for tuberculous infection.
Eight of 48 (9.7/10,000 person-days) exposed case patients vs four of 192 (0.8/10,000 person-days) nonexposed case patients developed active TB (relative risk [RR] = 11; 95% confidence interval [CI], 2.3, 50.3). Positive PPDs (greater than or equal to 10 mm of induration) in HCWs were associated with older age (P = .0001) and with history of community TB exposure (P = .0002). In a multivariable logistic model that adjusted for these variables, HIV unit nurses (nine of 19) and nurses in the internal medicine ward (45 of 90) had a higher proportion of positive PPDs than the reference group (clerical personnel on other floors: 35 of 188, P = .0005).
These data suggest that patient-to-patient transmission of TB in HIV units can occur and that HCWs are at risk of acquiring TB infection.
评估医院内结核病（TB）的传播情况。
对住院的人类免疫缺陷病毒（HIV）患者进行历史性队列研究，并对医护人员（HCWs）进行纯化蛋白衍生物（PPD）结核菌素皮肤试验调查。
波多黎各圣胡安的一家大型公立教学医院。
在队列研究中，病例患者定义为医院HIV科室中自入院31天或更晚至1989年12月31日期间培养出结核杆菌阳性的任何患者。在PPD调查中，医院的1420名医护人员中有908人同意参与并拥有足够的数据分析。
在队列研究中，比较接触过传染性结核病室友的患者中发生活动性结核病的风险与未接触患者的风险。在医护人员PPD调查中，确定结核感染的患病率和危险因素。
48名接触过的病例患者中有8名（9.7/10,000人日）发生活动性结核病，而192名未接触过的病例患者中有4名（0.8/10,000人日）发生活动性结核病（相对风险[RR]=11；95%置信区间[CI]，2.3，50.3）。医护人员中PPD阳性（硬结大于或等于10毫米）与年龄较大（P = 0.0001）和社区结核接触史（P = 0.0002）相关。在对这些变量进行调整的多变量逻辑模型中，HIV科室护士（19人中有9人）和内科病房护士（90人中有45人）的PPD阳性比例高于参考组（其他楼层的文职人员：188人中有35人，P = 0.0005）。
这些数据表明，HIV科室中结核病可在患者之间传播，且医护人员有感染结核病的风险。
