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Nosocomial Transmission of Mycobacterium tuberculosis From an Extrapulmonary Site

Published online by Cambridge University Press:  02 January 2015

Erika M.C. D'Agata ,
Sharon Wise ,
Amelia Stewart  and
Lewis B. Lefkowitz Jr
Erika M.C. D'Agata*
Affiliation:
Departments of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Sharon Wise
Affiliation:
Department of Infection Control, Maury Regional Hospital, Columbia, Tennessee
Amelia Stewart
Affiliation:
Tennessee Department of Health, Nashville, Tennessee
Lewis B. Lefkowitz Jr
Affiliation:
Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
*
Vanderbilt University Medical Center, Division of Infectious Diseases, Medical Center North A-3310, 21st Ave and Garland St, Nashville, TN 37232-2605
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Abstract

Objective:

To assess the extent of nosocomial transmission and risk factors associated with tuberculin skin test (TST) conversions among healthcare workers (HCWs) exposed to a patient with genitourinary Mycobacterium tuberculosis.

Design:

Retrospective cohort study of exposed HCWs.

Setting:

A 275-bed community hospital in Middle Tennessee.

Participants:

A total of 128 exposed HCWs and the index patient, who required drainage of a prostatic abscess and bilateral orchiectomy and expired after a 27-day hospitalization. Disseminated tuberculosis was diagnosed at autopsy.

Methods:

Contact tracing was performed on exposed HCWs. Logistic regression was used to identify independent risk factors associated with TST conversion.

Results:

A total of 128 HCWs were exposed to the index patient. There was no evidence of active pulmonary tuberculosis throughout the patient's hospitalization; TST conversions occurred only among HCWs who were exposed to the patient during or after his surgical procedures. A total of 12 (13%) of 95 exposed HCWs who were previously nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2 of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic regression, irrigation or packing of the surgical site was the only independent risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence interval, 1.2-67; P=.03).

Conclusion:

Manipulation of infected tissues of the genitourinary tract can result in nosocomial transmission of tuberculosis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 1 , January 2001 , pp. 10 - 12
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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