TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Clin Infect Dis. 2021 Jan 23;72(1):155-172. doi: 10.1093/cid/ciaa720.
Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, 1 of 7 commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in healthcare settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in healthcare workers (HCWs; absolute risk reductions 1%-21%); 5 reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and 2 in human immunodeficiency virus-positive in-patients (6%-29% reduction). In total, 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonizing study designs and reporting frameworks will permit formal data syntheses and facilitate policy making.
证据有限，无法确定感染预防和控制（IPC）措施能否减少医疗机构中结核分枝杆菌（MTB）的传播。本系统评价是世界卫生组织委托进行的 7 项研究之一，旨在为 2019 年全球结核病（TB）IPC 指南更新提供信息，主要问题是：分诊和/或隔离和/或有效治疗结核病能否减少医疗机构中的 MTB 传播？在 25 项纳入的研究中，19 项报告了医务人员（HCWs）中的潜伏性结核感染（LTBI）发病率（绝对风险降低 1%-21%）；5 项报告了 HCWs 中的结核病发病率（无/轻微[高结核负担]或中度[低负担]降低）和 2 项在人类免疫缺陷病毒阳性住院患者中的发病率（降低 6%-29%）。总的来说，23/25 项研究实施了多种 IPC 措施；无法对个别措施的效果进行细分。IPC 措施包似乎可以减少 MTB 传播，但单独或联合使用分诊、隔离或有效治疗的有效性的证据是间接的，且质量较低。协调研究设计和报告框架将允许进行正式的数据综合，并有助于制定政策。
