Preventive Medicine Service, Hospital Germans Trias i Pujol, Badalona, Spain.
Respir Med. 2013 Apr;107(4):601-7. doi: 10.1016/j.rmed.2012.12.008. Epub 2013 Jan 10.
To determine the incidence of latent tuberculosis infection (LTBI), and risk factors for tuberculosis skin test (TST) conversion among Healthcare workers (HCWs) during a 20-year follow-up period.
Prospective cohort analysis. Surveillance was conducted from January 1, 1988, to December 31, 2007.
600-bed tertiary referral hospital in Barcelona, Spain.
HCWs in risk for occupational tuberculosis (TB) exposure, with negative baseline TST, direct contact with patients and/or biological samples and at least one follow-up visit with TST.
TST is performed in HCWs with no previous history of TB or no previous positive TST. When TST is negative this test is performed once a year in high-risk workers, or at least every 2 years according to the hospital's guidelines. In all cases an interview questionnaire to gather information on possible risk factors was performed.
The study included 614 HCWs, 27% worked in areas of risk for TB exposure. Annual incidence rate had decreased from 46.8 per 100 person-years in 1990 to 1.08 per 100 person-years in 2007. Cumulative incidence was higher in HCWs who work in high-risk areas (p = 0.004) and in time periods from 1990 to 1995, and from 1996 to 2001 (p < 0.0001). Cox regression model showed a hazard ratio of 1.55 (CI 95%; 1.05-2.27) in high-risk workers, adjusted by gender, age and professional status.
Incidence of LTBI among HCWs is high, although it decreased throughout the follow-up period. It is crucial to maintain surveillance programs in HCWs.
在 20 年的随访期间，确定潜伏性结核感染 (LTBI) 的发生率，以及医护人员 (HCWs) 中结核菌素皮肤试验 (TST) 转化的危险因素。
前瞻性队列分析。监测于 1988 年 1 月 1 日至 2007 年 12 月 31 日进行。
西班牙巴塞罗那的一家 600 床位的三级转诊医院。
有职业性结核病 (TB) 暴露风险的 HCWs，基线 TST 阴性，直接接触患者和/或生物样本，并且至少有一次 TST 随访。
在没有 TB 既往史或既往 TST 阳性的 HCWs 中进行 TST。当 TST 阴性时，高风险工作人员每年进行一次此项检查，或根据医院的指南每 2 年进行一次。在所有情况下，都会进行访谈问卷，以收集可能的危险因素信息。
这项研究共纳入 614 名 HCWs，其中 27%的人在有 TB 暴露风险的区域工作。年发病率从 1990 年的 46.8/100 人年降至 2007 年的 1.08/100 人年。在高风险区域工作的 HCWs（p=0.004）和在 1990 年至 1995 年以及 1996 年至 2001 年期间（p<0.0001）的累积发病率更高。Cox 回归模型显示，在高风险工作人员中，性别、年龄和职业状况调整后的危险比为 1.55（95%CI 1.05-2.27）。
尽管在整个随访期间，HCWs 中的 LTBI 发生率有所下降，但仍居高不下。因此，对 HCWs 进行监测计划至关重要。
