结核菌素皮肤试验转阳率评估医护人员发生肺结核感染的暴露后率：意大利一所教学医院 6 年经验。
Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital.
机构信息
Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, viale Camillo Golgi 19, Pavia 27100, Italy.
出版信息
BMC Infect Dis. 2014 Jun 12;14:324. doi: 10.1186/1471-2334-14-324.
BACKGROUND
This study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented.
METHODS
All HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI).
RESULTS
Fourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01).
CONCLUSIONS
PEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected.
背景
本研究评估了我院在接触延迟诊断的结核病患者且未采取呼吸防护措施的 HCWs 中潜伏性结核感染（LTBI）的风险。
方法
纳入所有接触过文化确诊的肺结核患者且未采取呼吸防护措施的 HCWs。记录过去（定义为 T0）进行的 TST 结果数据。TST 进行了两次：第一次是在接触索引患者后立即（T1），第三次是在三个月后（T2）。T0 到 T1 的时间段用于计算结核感染年发生率（ARTI），而 T1 到 T2 的时间段用于计算暴露后结核感染年发生率（PEARTI）。
结果
共收治了 14 例索引患者，其中痰涂片阳性 7 例（58.3%），非意大利籍患者 4 例（28.6%）。有 388 名 HCWs 接触过索引患者，每个索引患者平均有 27 名（12-39 名）HCWs。过去有 180 名（46.4%）HCWs 接种过卡介苗。在这个亚组中，过去有 122 名（31%）HCWs 的 TST 呈阳性且未进行评估。在过去 TST 检测结果为阴性的 255 名 HCWs 中，T1 时 TST 阳性者有 11 名（4.3%）。ARTI 为每 100 人年 1.6（95%CI 0.9-2.9）。T2 时 TST 阳性的 9 名（3.7%）HCWs 在 T1 时 TST 阴性。PEARTI 为每 100 人年 26（95%CI 13.6-50）。单因素分析显示，年龄较大与暴露后潜伏性结核感染相关（HR 1.12；95%CI 1.03-1.22，p=0.01）。
结论
接触索引患者的 HCWs 的 PEARTI 明显高于 ARTI。这些数据强调了快速诊断以及在怀疑结核病时采取适当呼吸防护措施的重要性。
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