Nosocomial transmission has been described in extensively drug resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about rates of drug-resistant TB among healthcare workers (HCWs) in TB and HIV endemic settings.
To estimate rates of multi-drug resistant tuberculosis (MDR-TB) and XDR-TB hospitalizations among HCWs in KwaZulu-Natal (KZN), South Africa.
Retrospective study of drug-resistant TB patients admitted for the initiation of drug-resistant TB therapy between 2003 and 2008.
A public TB referral hospital in KZN, South Africa.
HCWs admitted with MDR-TB (N=203) or XDR-TB (N=28) were compared with non-HCWs admitted with MDR-TB (N=3807) or XDR-TB (N=344).
Hospital admission rates, hospital admission incidence rate ratios.
Estimated incidence of MDR-TB hospitalization was 64.8/100,000 for HCWs versus 11.9/100,000 for non-HCWs (I.R.R. 5.56 95% C.I. 4.87–6.35). Estimated incidence of XDR-TB hospitalizations was 7.2/100,000 among HCWs versus 1.1/100,000 in non-HCWs (I.R.R. 6.69 95% C.I. 4.38–10.20). A higher percentage of HCWs than non-HCWs with MDR-TB or XDR-TB were female (78% vs. 47%, p<0.001) and fewer HCWs reported previous TB treatment (41% vs. 92%, p<0.001). Prevalence of HIV infection did not differ between HCW and non-HCW (55% vs. 57%, p=0.71), but a higher percentage of HIV infected HCWs were on antiretroviral medications (63% vs. 47%, p<0.001).
HCWs in this HIV-endemic area were substantially more likely to be hospitalized with either MDR-TB or XDR-TB compared to non-HCWs. The increased risk may be explained by occupational exposure and not by other risk factors, underlining the urgent need for TB infection control programs.
Primary Funding Source
No funding was received for this study