Institute of Microbiology and Laboratory Medicine, Department IML Red GmbH, WHO, Supranational Tuberculosis Reference Laboratory, Robert-Koch-Allee 2, Gauting, 82131, Munich, Germany.
Republican Tuberculosis Reference Laboratory, Bishkek, Kyrgyzstan.
BMC Infect Dis. 2022 Feb 23;22(1):180. doi: 10.1186/s12879-022-07149-0.
Health care workers (HCW) are at increased risk of TB infection due to their close contact with infected patients with active TB. The objectives of the study were (1) to assess the prevalence of LTBI among HCW in the Northern Kyrgyz Republic, and (2) to determine the association of LTBI with job positions or departments.
HCWs from four TB hospitals in the Northern Kyrgyz Republic were tested with the interferon-gamma release assay (IGRA) Quantiferon-TB Gold plus (QFT) for the detection of an immune response to TB as marker of TB infection. Age was controlled for as a confounder. Univariate and multivariable analysis were performed using logistic regression to assess the association of the risk factors (job position, and department) with having a QTF positive result. Firth's penalized-likelihood estimates were used to account for the small-sample size. Pairwise comparisons using the Bonferroni correction (conservative) and comparisons without adjusting for multiple comparisons (unadjusted) were used to identify the categories where differences occurred.
QFT yielded valid results for 404 HCW, with 189 (46.7%) having a positive test. In the National Tuberculosis Center there was an increased odds to have a positive QFT test for the position of physician (OR = 8.7, 95%, CI = 1.2-60.5, p = 0.03) and laboratory staff (OR = 19.8, 95% CI = 2.9-135.4, p < 0.01) when administration staff was used as the baseline. When comparing departments for all hospitals combined, laboratories (OR 7.65; 95%CI 2.3-24.9; p < 0.001), smear negative TB (OR 5.90; 95%CI 1.6-21.8; p = 0.008), surgery (OR 3.79; 95%CI 1.3-11.4; p = 0.018), and outpatient clinics (OR 3.80; 95%CI 1.1-13.0; p = 0.03) had higher odds of a positive QFT result than the admin department. Fifteen of the 49 HCW with follow-up tests converted from negative to positive at follow-up testing.
This is the first report on prevalence and risk factors of LTBI for HCW in the Kyrgyz republic, and results indicate there may be an increased risk for LTBI among physicians and laboratory personnel. Further research should investigate gaps of infection control measures particularly for physicians and laboratory staff and lead to further improvement of policies.
由于医护人员（HCW）与活动性肺结核患者密切接触，因此他们感染结核的风险增加。本研究的目的是：（1）评估在吉尔吉斯斯坦北部，HCW 的 LTBI 患病率；（2）确定 LTBI 与职位或部门的关联性。
对吉尔吉斯斯坦北部四家结核病医院的 HCW 进行了干扰素-γ释放试验（IGRA）——QuantiFERON-TB Gold plus（QFT）检测，以检测针对结核的免疫反应作为结核感染的标志物。年龄是混杂因素。采用逻辑回归进行单变量和多变量分析，以评估危险因素（职位和部门）与 QFT 阳性结果的关联。使用 Firth 惩罚似然估计来解释小样本量的问题。使用 Bonferroni 校正（保守）进行两两比较，以及不进行多次比较调整（未调整）的比较，以确定出现差异的类别。
QFT 对 404 名 HCW 产生了有效结果，其中 189 名（46.7%）检测结果为阳性。在国家结核病中心，医生（比值比[OR] = 8.7，95%置信区间[CI] = 1.2-60.5，p = 0.03）和实验室工作人员（OR = 19.8，95%CI = 2.9-135.4，p < 0.01）的阳性 QFT 检测结果的几率更高，而行政人员为基础时，阳性 QFT 检测结果的几率更高。当比较所有医院的科室时，实验室（OR 7.65；95%CI 2.3-24.9；p < 0.001）、痰涂片阴性的结核病（OR 5.90；95%CI 1.6-21.8；p = 0.008）、外科（OR 3.79；95%CI 1.3-11.4；p = 0.018）和门诊（OR 3.80；95%CI 1.1-13.0；p = 0.03）的 QFT 阳性结果几率更高。在随访测试中，有 15 名随访测试从阴性转为阳性的 49 名 HCW。
这是吉尔吉斯斯坦共和国首次报告 HCW 的 LTBI 患病率和危险因素，结果表明，医生和实验室人员的 LTBI 风险可能增加。进一步的研究应调查感染控制措施的差距，特别是针对医生和实验室工作人员，并进一步改进政策。
