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Nosocomial Tuberculosis: An Outbreak of a Strain Resistant to Seven Drugs

Published online by Cambridge University Press:  02 January 2015

Robin M. Ikeda*
Affiliation:
Epidemic Intelligence Service, Division of Field Epidemiology, Epidemiology Program Office, Atlanta, Georgia Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York
Guthrie S. Birkhead
Affiliation:
Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York Department of Epidemiology, School of Public Health, State University of New York at Albany, Albany, New York
George T. DiFerdinando Jr
Affiliation:
Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York Department of Epidemiology, School of Public Health, State University of New York at Albany, Albany, New York
Donald L. Bornstein
Affiliation:
Health Science Center, State University of New York, Syracuse, New York
Samuel W. Dooley
Affiliation:
Division of Tuberculosis Elimination, Centers for Disease Control and prevention, Atlanta, Georgia
Dale L. Morse
Affiliation:
Bureau of Communicable Disease Control, New York State Department of Health, Albany, New York Department of Epidemiology, School of Public Health, State University of New York at Albany, Albany, New York
*
Division of Violence Prevention. Centers for Disease Control and Prevention. 4770 Buford Hwy., MS K-60, Atlanta, GA 30341

Abstract

Objective:

To evaluate nosocomial transmission of multidrug-resistant (MDR) tuberculosis (TB).

Design:

Outbreak investigation: review of infection control practices and skin test results of healthcare workers (HCWs); medical records of hospitalized TB patients and mycobacteriology reports; submission of specimens for restriction fragment length polymorphism (RFLP) typing; and an assessment of the air-handling system.

Setting:

A teaching hospital in upstate New York.

Results:

Skin-test conversions occurred among 46 (6.6%) of 696 HCWs tested from August through October 1991. Rates were highest on two units (29% and 20%); HCWs primarily assigned to these units had a higher risk for conversion compared with HCWs tested following previous incidents of exposure to TB (relative risk [RR] = 53.4, 95% confidence interval [CI95] =6.9 to 411.1; and RR=37.4, CI95= 5.0 to 277.3, respectively). The likely source patient was the only TB patient hospitalized on both units during the probable exposure period. This patient appeared clinically infectious, was associated with a higher risk of conversion among HCWs providing direct care (RR = 2.37; CI95 = 1.05 to 5.34), and was a prison inmate with TB resistant to seven antituberculosis agents. The MDR-TB strain isolated from this patient also was isolated from other inmate and noninmate patients, and a prison correctional officer exposed in the hospital. Mycobacterium tuberculosis isolates from all of these patients had matching RFLP patterns. Infection control practices closely followed established guidelines; however, several rooms housing TB patients had marginal negative pressure with variable numbers of air changes per hour, and directional airflow was disrupted easily.

Conclusions:

These data strongly suggest nosocomial transmission of MDR-TB to HCWs, patients, and a prison correctional officer working in the hospital. Factors contributing to transmission apparently included prolonged infectiousness of the likely source patient and inadequate environmental controls. Continued urgent attention to TB infection control is needed.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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