High Rates of Potentially Infectious Tuberculosis and Multidrug-Resistant Tuberculosis (MDR-TB) among Hospital Inpatients in KwaZulu Natal, South Africa Indicate Risk of Nosocomial Transmission

Abstract

BackgroundNosocomial transmission has been implicated as a key factor in the outbreak of extensively drug resistant (XDR) and multidrug-resistant (MDR-TB) tuberculosis at Church of Scotland Hospital (CoSH), in KwaZulu-Natal (KZN), South Africa. The aim of this study was to quantify the burden of potentially infectious tuberculosis and the proportion of drug resistance among hospital inpatients throughout the province of KZN.MethodsInpatients with current cough, capable of producing sputum were selected from 19 public hospitals in KZN. After informed consent, demographic and clinical data, and sputum samples were collected. Samples were processed for fluorescent microscopy, liquid culture and first and second-line anti-tuberculosis drug susceptibility testing.ResultsThere were a total of 2,964 inpatients where sampling was done. About 1,585 inpatients (53%) had a current cough and sufficient microbiological and clinical data for inclusion. Mycobacterium tuberculosis was isolated from 543 inpatients (34% of those tested and 18% of all inpatients). Eighty-four (15%) inpatients with TB were found to be MDR-TB infected and 16 (3%) had XDR-TB. There was no association between the prevalence of MDR-TB and proximity to CoSH. Among patients with microbiologically confirmed TB, MDR/XDR-TB was associated with male sex, a longer length of stay between hospital admission and date of sample collection, and current or previous TB treatment.ConclusionsOne in five inpatients had potentially infectious TB. This is an underestimate since patients without current cough were not tested. MDR-TB was frequently observed and was found in nearly one in six active TB inpatients. While present at lower levels than the original outbreak report at CoSH, XDR-TB was detected in hospitals throughout KZN. The high burden of potentially infectious TB and confirmed MDR-TB, much of it undiagnosed, indicates a serious risk for nosocomial transmission and the need for intensified infection control within the inpatient setting.

Mycobacterium tuberculosis Drug Resistance and Transmission among Human Immunodeficiency Virus–Infected Patients in Ho Chi Minh City, Vietnam

“…8,16 We did not observe large strain clusters, indicative of recent transmission and potential poor infection control practices in health-care centers, as documented in KwaZulu-Natal, South Africa. 26 Being able to compare strains from HIVinfected patients with those in the general community provided an unprecedented opportunity to map the dynamic exchange of M. tuberculosis strains between HIV-infected and uninfected individuals in the same population. The fact that strains from HIV-infected patients were interspersed with community strains indicates that most HIV-infected patients acquired M. tuberculosis infection in the general community, with limited person-to-person transmission among HIVinfected patients.…”

Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases

“…Subsequent molecular strain typing and social network analyses demonstrated that 82% of patients may have acquired their infection in hospital. Studies in the surrounding community showed no increased XDR-TB prevalence [40], reinforcing the role of hospitals and clinics as important sites of potential TB transmission. The outbreak also highlighted the risk of transmission and poor outcomes seen for people living with HIV exposed to drug resistant disease.…”

Treatment Delay among Smear Positive Pulmonary Tuberculosis Patients in South Ethiopia: A Cross-Sectional Study

“…These findings indicate that variables affecting the prompt treatment of TB vary according to geographical location and population, calling for studies intended to estimate and identify area and population specific factors associated with increased delay of the patients for treatment. Delayed diagnosis of pulmonary TB is also associated with drug resistance as indicated in one study conducted in South Africa [20]. Therefore, in the present study we have estimated the total delay defined as time from onset of TB symptoms, cough being the most prominent, to initiation of anti-TB treatment among smear-positive pulmonary TB patient in South Ethiopia.…”