Uden Lydia, Barber Ella, Ford Nathan, Cooke Graham S
Division of Infectious Diseases, Imperial College London.
Manson Unit, Médecins Sans Frontières, London, UK; and.
Open Forum Infect Dis. 2017 Aug 29;4(3):ofx137. doi: 10.1093/ofid/ofx137. eCollection 2017 Summer.
Tuberculosis (TB) remains a major challenge to global health. Healthcare workers (HCWs) appear to be at increased risk of TB compared with the general population, despite efforts to scale up infection control and reduce nosocomial TB transmission. This review aims to provide an updated estimate of the occupational risk of latent TB infection (LTBI) and active TB among HCWs compared with the general population.
A systematic review was performed to identify studies published over the last 10 years reporting TB prevalence or incidence among HCWs and a control group. Pooled effect estimates were calculated to determine the risk of infection.
Twenty-one studies met the inclusion criteria, providing data on 30961 HCWs across 16 countries. Prevalence of LTBI among HCWs was 37%, and mean incidence rate of active TB was 97/100000 per year. Compared with the general population, the risk of LTBI was greater for HCWs (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.61-3.20), and the incidence rate ratio for active TB was 2.94 (95% CI, 1.67-5.19). Comparing tuberculin skin test and interferon-gamma release assay, OR for LTBI was found to be 1.72 and 5.61, respectively.
The overall risk of both LTBI and TB to HCWs continues to be significantly higher than that of the general population, consistent with previous findings. This study highlights the continuing need for improvements in infection control and HCW screening programs.
结核病仍然是全球卫生面临的重大挑战。尽管已努力扩大感染控制并减少医院内结核病传播，但医护人员感染结核病的风险似乎高于普通人群。本综述旨在提供与普通人群相比，医护人员中潜伏性结核感染（LTBI）和活动性结核病职业风险的最新估计。
进行了一项系统综述，以确定过去10年发表的报告医护人员和对照组结核病患病率或发病率的研究。计算合并效应估计值以确定感染风险。
21项研究符合纳入标准，提供了16个国家30961名医护人员的数据。医护人员中LTBI的患病率为37%，活动性结核病的平均发病率为每年97/100000。与普通人群相比，医护人员发生LTBI的风险更高（优势比[OR]，2.27；95%置信区间[CI]，1.61 - 3.20），活动性结核病的发病率比为2.94（95%CI，1.67 - 5.19）。比较结核菌素皮肤试验和干扰素 - γ释放试验，发现LTBI的OR分别为1.72和5.61。
与之前的研究结果一致，LTBI和结核病对医护人员的总体风险仍然显著高于普通人群。本研究强调持续改进感染控制和医护人员筛查计划的必要性。
