Quantifying the contribution of smear-negative, culture-positive pulmonary tuberculosis to nosocomial transmission - 05/03/24

Doi : 10.1016/j.ajic.2024.02.005

Ya-Jen Yang, MPH ^a, Sung-Ching Pan, PhD ^a,^b, Meng-Rui Lee, PhD ^b, Che-Liang Chung, MD ^c, Chia-Ping Ku, MSc ^a, Chi-Yu Liao, MEd ^a, Tien-Yu Tsai, BN ^a, Jann-Yuan Wang, PhD ^b,^⁎ , Chi-Tai Fang, PhD ^b,^d,^e,^f,^⁎ , Yee-Chun Chen, PhD ^a,^b
^a Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
^b Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
^c Department of Internal Medicine, Yuanlin Christian Hospital, Changhua, Taiwan
^d Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
^e Population Health Research Center, National Taiwan University, Taipei, Taiwan
^f Ministry of Health and Welfare and National Taiwan University Infectious Disease Research and Education Center, Taipei, Taiwan

^⁎Address correspondence to Jann-Yuan Wang, PhD, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan.Department of Internal Medicine, National Taiwan University Hospital7 Chung Shan South RoadTaipei100Taiwan^⁎⁎Address correspondence to Chi-Tai Fang. PhD, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 100, Taiwan.Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University17 Xu-Zhou RoadTaipei100Taiwan

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Résumé

Background

Despite current guidelines for tuberculosis (TB) control in health care settings, which focused on smear-positive cases, prevention of nosocomial TB transmission continues to be a challenge. Here, we report the results of the first hospital-wide prospective study applying interferon-gamma release assay to investigate the role of smear-negative, culture-positive index cases in nosocomial TB transmission.

Methods

We prospectively identified cases of culture-confirmed smear-negative pulmonary TB receiving aerosol-generating procedures (AGPs) and cases of culture-confirmed smear-positive pulmonary TB admitted at a medical center. Nosocomial transmission was evaluated by screening their close contacts for latent TB infection (LTBI) using an interferon-gamma release assay.

Results

A total of 93 smear-negative index receiving AGP and 122 smear-positive index were enrolled. Among them, 13 (14.0%) and 43 (35.2%) index cases, respectively, had secondary cases of LTBI (P < .001). Sputum smear negativity (adjusted odds ratio: 0.20 [0.08-0.48]) and AGP (sputum suction; adjusted odds ratio: 3.48 [1.34-9.05]) are independent factors of transmission. A similar proportion in the close contacts of the 2 index groups had LTBI (17 [15.3%] and 63 [16.0%], respectively), and the former index group contributed to 21.3% of the nosocomial transmission.

Conclusions

Smear-negative, culture-positive index cases receiving AGPs could be as infectious as smear-positive index cases. Hospital TB control policy should also focus on the former group.

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Highlights

•	The role of smear-negative index cases in nosocomial transmission remains unknown.
•	Smear-negative cases receiving AGPs could be as infectious as smear-positive cases.
•	Smear-negative cases may be responsible for 21.3% nosocomial TB transmissions.
•	Ongoing physician education to optimize the utilization of TB-NAAT is imperative.
•	Hospital TB control should also focus on smear-negative index receiving AGPs.

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Key Words : Acid-fast smear, Contact investigation, Interferon-gamma releasing assay (IGRA), Latent tuberculosis infection, Aerosol-generating procedure

Plan

Background

Methods

Study design and population

Ethics approval and consent to participate

Author Contributions

Funding/support: This study is supported by the National Taiwan University Hospital (NTUH) and Population Health Research Center from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Taiwan Ministry of Education (grant number NTU-112L9004). The publication of this article is supported by Ministry of Health and Welfare and National Taiwan University Infectious Disease Research and Education Center (Taipei, Taiwan). The funders have no role in study design, data collection and analysis, preparation of manuscript, or decision to submission.

Conflicts of interest: None to report.