Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Pharmacy, New Taipei City Hospital, New Taipei, Taiwan.
Respirology. 2015 Nov;20(8):1233-40. doi: 10.1111/resp.12612. Epub 2015 Aug 11.
This retrospective national surveillance study investigated the burden of and risk factors for nosocomial exposure of pulmonary tuberculosis (TB) in intensive care units.
Patients admitted to intensive care units were identified from the National Health Insurance Research Database. During 2004-2009, there were 1 387 707 intensive care unit admissions of 900 562 adult patients. Pulmonary tuberculosis association was considered if the patient was diagnosed with pulmonary tuberculosis during admission or within 3 months after discharge. Nosocomial transmissible period was calculated based on the length of anti-tuberculosis treatment and negative-pressure isolation during admission.
Pulmonary tuberculosis was associated with 1.20% of all intensive care unit admissions and 6731 (38.9%) started anti-TB treatment during admission. For the other 10 583 admissions, the diagnosis was made after discharge and anti-TB treatment was not prescribed during admission. The probability paralleled the regional tuberculosis incidence. On average, 2794 pulmonary tuberculosis associated intensive care unit admissions contributed to 42 999-44 062 days of nosocomial exposure per year. The length of nosocomial transmissible period decreased with the gradual implementation of Mycobacterium tuberculosis nucleic acid amplification tests in intensive care practice. Multivariate linear regression analysis revealed that the length of nosocomial transmissible period was inversely associated with male gender, airway symptoms prior to admission and performing M. tuberculosis nucleic acid amplification tests and mycobacterial culture.
Nosocomial tuberculosis exposure is not uncommon in intensive care units. Performing rapid molecular diagnostic tests in those suspected of tuberculosis is recommended to reduce the risk of nosocomial exposure.
本回顾性全国监测研究调查了重症监护病房（ICU）中肺结核（TB）医院感染的负担和危险因素。
从国家健康保险研究数据库中确定入住 ICU 的患者。2004-2009 年期间，900562 例成人患者中有 1387707 例入住 ICU。如果患者在住院期间或出院后 3 个月内被诊断患有肺结核，则认为与肺结核有关。根据抗结核治疗和住院期间负压隔离的时间计算医院内传染性时间。
肺结核与所有 ICU 入住的 1.20%和 6731 例（38.9%）有关，这些患者在住院期间开始抗结核治疗。对于其他 10583 例入住，诊断是在出院后做出的，并且在住院期间未开具抗结核治疗。这种概率与区域结核病发病率平行。平均而言，每年有 2794 例与肺结核相关的 ICU 入住导致 42999-44062 天的医院内暴露。随着结核分枝杆菌核酸扩增检测在重症监护实践中的逐步实施，医院内传染性时间的长度逐渐缩短。多元线性回归分析显示，医院内传染性时间的长度与男性性别、入院前气道症状以及进行结核分枝杆菌核酸扩增检测和分枝杆菌培养呈负相关。
在 ICU 中，医院内结核病暴露并不罕见。建议对疑似结核病患者进行快速分子诊断检测，以降低医院内暴露的风险。
