Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Chest. 2012 Jul;142(1):55-62. doi: 10.1378/chest.11-0992.
Clinical data with use of serial interferon-γ release assay (IGRA) testing in US health-care workers (HCWs) are limited.
A single-center, retrospective chart review was done from 2007 to 2010 of HCWs who underwent preemployment QuantiFERON-TB Gold In-Tube testing. Demographic data, bacille Calmette-Guérin history, prior tuberculin skin test result if done, and baseline and serial IGRA values were obtained. The number of IGRA converters and reverters and their subsequent management by infectious disease physicians were reviewed. Quantitative IGRA-negative values were not available.
A total of 7,374 IGRAs were performed on newly hired HCWs. Of these tests, 486 (6.6%) were positive at baseline, 305 (4.1%) were indeterminate, and 6,583 (89.3%) were negative. From 2007 to 2010, 52 of 1,857 HCWs (2.8%) with serial IGRA tests were identified as converters, with a serial IGRA median value of 0.63 IU/mL. Seventy-one percent of HCWs with IGRA conversion had values ≤ 1 IU/mL. None of the converters had active TB or were part of an outbreak investigation.
Clinical significance of most QuantiFERON-TB Gold In-Tube conversions in serial testing remains a challenging task for clinicians. The use of a single cutoff point criterion for IGRA may lead to overdiagnosis of new TB infections. Clinical assessment and evaluation may help to prevent unnecessary therapy in these cases. The criteria for defining conversions and reversions by establishing new cutoffs needs to be evaluated further, especially in HCWs.
美国卫生保健工作者（HCWs）使用干扰素-γ释放试验（IGRA）检测的临床数据有限。
对 2007 年至 2010 年期间接受入职前 QuantiFERON-TB Gold In-Tube 检测的 HCWs 进行了一项单中心、回顾性图表审查。获取了人口统计学数据、卡介苗史、如果进行过结核菌素皮肤试验的结果以及基线和连续 IGRA 值。审查了 IGRA 转换者和逆转者的数量及其随后由传染病医生进行的管理。无法获得定量 IGRA 阴性值。
对新入职的 HCWs 共进行了 7374 次 IGRA。这些检测中，486 次（6.6%）基线阳性，305 次（4.1%）为不确定，6583 次（89.3%）为阴性。从 2007 年到 2010 年，在 1857 名连续进行 IGRA 检测的 HCWs 中，有 52 名（2.8%）被确定为转换者，其连续 IGRA 中位数为 0.63IU/mL。IGRA 转换者中有 71%的人值≤1IU/mL。没有转换者患有活动性结核病或参与暴发调查。
对于临床医生来说，大多数 QuantiFERON-TB Gold In-Tube 连续检测中的 IGRA 转换的临床意义仍然是一项具有挑战性的任务。使用单一截止值标准进行 IGRA 可能导致新的结核病感染过度诊断。在这些情况下，临床评估和评估可能有助于预防不必要的治疗。需要进一步评估建立新截止值来定义转换和逆转的标准，特别是在 HCWs 中。
