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
Nosocomial 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 i...
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| Veröffentlicht in: | PloS one 2014-03, Vol.9 (3), p.e90868-e90868 |
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| creator | Bantubani, Nonkqubela Kabera, Gaetan Connolly, Catherine Rustomjee, Roxana Reddy, Tarylee Cohen, Ted Pym, Alexander S |
| description | Nosocomial 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.
Inpatients 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.
There 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.
One 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. |
| doi_str_mv | 10.1371/journal.pone.0090868 |
| format | Article |
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Inpatients 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.
There 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.
One 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0090868</identifier><identifier>PMID: 24625669</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Antitubercular Agents - therapeutic use ; Biology ; Cough ; Councils ; Cross Infection - drug therapy ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Demographics ; Disease control ; Disease Outbreaks ; Disease transmission ; Drug resistance ; Extensively Drug-Resistant Tuberculosis - drug therapy ; Extensively Drug-Resistant Tuberculosis - epidemiology ; Female ; Fluorescence ; Health aspects ; HIV ; Hospital patients ; Hospitals ; Human immunodeficiency virus ; Humans ; Infections ; Infectious diseases ; Informed consent ; Inpatients ; Liquid culture ; Male ; Medical research ; Medicine ; Microbial drug resistance ; Microbial Sensitivity Tests ; Microscopy ; Microscopy, Fluorescence ; Middle Aged ; Multidrug resistance ; Multidrug resistant organisms ; Mycobacterium tuberculosis ; Mycobacterium tuberculosis - isolation & purification ; Nosocomial infection ; Outbreaks ; Patients ; Population ; South Africa - epidemiology ; Sputum ; Tuberculosis ; Tuberculosis - drug therapy ; Tuberculosis - epidemiology ; Tuberculosis, Multidrug-Resistant - drug therapy ; Tuberculosis, Multidrug-Resistant - epidemiology</subject><ispartof>PloS one, 2014-03, Vol.9 (3), p.e90868-e90868</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Bantubani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Bantubani et al 2014 Bantubani et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-6caff380c5917dbf7a1ea003c7b8f9e498795fd085aeac51148bbad91973c58d3</citedby><cites>FETCH-LOGICAL-c593t-6caff380c5917dbf7a1ea003c7b8f9e498795fd085aeac51148bbad91973c58d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953209/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953209/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24625669$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Pai, Madhukar</contributor><creatorcontrib>Bantubani, Nonkqubela</creatorcontrib><creatorcontrib>Kabera, Gaetan</creatorcontrib><creatorcontrib>Connolly, Catherine</creatorcontrib><creatorcontrib>Rustomjee, Roxana</creatorcontrib><creatorcontrib>Reddy, Tarylee</creatorcontrib><creatorcontrib>Cohen, Ted</creatorcontrib><creatorcontrib>Pym, Alexander S</creatorcontrib><title>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</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Nosocomial 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.
Inpatients 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.
There 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.
One 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. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bantubani, Nonkqubela</au><au>Kabera, Gaetan</au><au>Connolly, Catherine</au><au>Rustomjee, Roxana</au><au>Reddy, Tarylee</au><au>Cohen, Ted</au><au>Pym, Alexander S</au><au>Pai, Madhukar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-03-13</date><risdate>2014</risdate><volume>9</volume><issue>3</issue><spage>e90868</spage><epage>e90868</epage><pages>e90868-e90868</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Nosocomial 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.
Inpatients 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.
There 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.
One 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24625669</pmid><doi>10.1371/journal.pone.0090868</doi><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_plos_journals_1507247115 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Antitubercular Agents - therapeutic use Biology Cough Councils Cross Infection - drug therapy Cross Infection - epidemiology Cross Infection - microbiology Demographics Disease control Disease Outbreaks Disease transmission Drug resistance Extensively Drug-Resistant Tuberculosis - drug therapy Extensively Drug-Resistant Tuberculosis - epidemiology Female Fluorescence Health aspects HIV Hospital patients Hospitals Human immunodeficiency virus Humans Infections Infectious diseases Informed consent Inpatients Liquid culture Male Medical research Medicine Microbial drug resistance Microbial Sensitivity Tests Microscopy Microscopy, Fluorescence Middle Aged Multidrug resistance Multidrug resistant organisms Mycobacterium tuberculosis Mycobacterium tuberculosis - isolation & purification Nosocomial infection Outbreaks Patients Population South Africa - epidemiology Sputum Tuberculosis Tuberculosis - drug therapy Tuberculosis - epidemiology Tuberculosis, Multidrug-Resistant - drug therapy Tuberculosis, Multidrug-Resistant - epidemiology |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T04%3A34%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=High%20rates%20of%20potentially%20infectious%20tuberculosis%20and%20multidrug-resistant%20tuberculosis%20(MDR-TB)%20among%20hospital%20inpatients%20in%20KwaZulu%20Natal,%20South%20Africa%20indicate%20risk%20of%20nosocomial%20transmission&rft.jtitle=PloS%20one&rft.au=Bantubani,%20Nonkqubela&rft.date=2014-03-13&rft.volume=9&rft.issue=3&rft.spage=e90868&rft.epage=e90868&rft.pages=e90868-e90868&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0090868&rft_dat=%3Cgale_plos_%3EA478769272%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1507247115&rft_id=info:pmid/24625669&rft_galeid=A478769272&rft_doaj_id=oai_doaj_org_article_b0b8de7a86f246f887c9eedcf66b9bc1&rfr_iscdi=true |