tailieunhanh - The potential to transmit Mycobacterium tuberculosis at a South African tertiary teaching hospital

The tuberculosis (TB) epidemic is historically anchored in South Africa’s Western Cape province, and long precedes the HIV epidemic. This is despite the generally better socio-economic status of the population and greater overall healthcare expenditure in this region than in other provinces. Contributing factors include overcrowding, alcohol abuse, poverty, and administrative neglect of the National TB Programme (NTP).1 This traditional ‘Cape’ epidemic is now being significantly augmented by an HIVassociated TB epidemic. Multidrug-resistant TB (MDR-TB), defined as disease caused by strains with resistance to at least isoniazid and rifampin,2 was first identified in the Western Cape in 1985; within nine years, MDR-TB accounted for 2% of TB isolates in this There. | International Journal of Infectious Diseases 14 2010 e423-e428 ELSEVIER Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage locate ijid The potential to transmit Mycobacterium tuberculosis at a South African tertiary teaching hospital D. Sissolaka . Bamford b S. Mehtara a Academic Unit for Infection Prevention and Control Department of Interdisciplinary Health Sciences Faculty of Health Sciences University of Stellenbosch and Tygerberg Hospital H9 9th Floor East Private Bag x3 Stellenbosch South Africa b National Health Laboratory Service NHLS Tygerberg and Department of Medical Microbiology and Immunology Faculty of Health Sciences University of Stellenbosch Stellenbosch South Africa ARTICLE INFO ABSTRACT Article history Received 8 December 2008 Received in revised form 29 May 2009 Accepted 26 June 2009 Keywords Pulmonary tuberculosis Infection control Nosocomial transmission Objectives To assess the risk of nosocomial transmission by confirmed pulmonary tuberculosis PTB patients in a high TB HIV incidence environment. Methods Between November 2006 and April 2007 we carried out a cross-sectional survey of PTB patients with positive smears or cultures at an academic tertiary hospital in the Western Cape South Africa. Results Of 394 confirmed PTB patients only 199 had a known HIV status of whom 107 were HIV-co-infected. Sensitivity testing for Mycobacterium tuberculosis TB was done in of patients with available cultures 140 284 . Of these patients 13 140 had multidrug-resistant MDR TB strains. The turnaround times TAT for culture and susceptibility testing were delayed mean TAT for cultures was 27 days range 63 days and for susceptibility testing was 42 days range 63 days . One fifth of PTB patients 82 394 were diagnosed from wards that do not deal with TB on a daily basis. PTB inpatients were hospitalized for an average of 13 days and were on average transferred twice. Only .