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.
Highlights
HIV has had a huge impact on the incidence of tuberculosis (TB) cases in sub-Saharan Africa [1]
In 2012 65% of HIV tested tuberculosis cases were co-infected with HIV [3] and together these two pathogens are responsible for an estimated 46% of disability-adjusted life years (DALY) lost in South Africa [1]
While the HIV epidemic alone has complicated local responses and increased resource demands on an already strained public health system, the spread of drug-resistant TB (DR-TB) within South Africa constitutes an additional challenge to effective control of the disease
Summary
HIV has had a huge impact on the incidence of tuberculosis (TB) cases in sub-Saharan Africa [1]. In 2012 65% of HIV tested tuberculosis cases were co-infected with HIV [3] and together these two pathogens are responsible for an estimated 46% of disability-adjusted life years (DALY) lost in South Africa [1]. Based on data from the most recent national Drug Resistance Survey in 2002, South Africa had an estimated burden of approximately 13,000 multidrug-resistant TB (MDR-TB) cases [4]. MDR-TB is defined as resistant to isoniazid and rifampin This MDR-TB burden places South Africa on the 5th position among countries with the highest global incidence of MDR-TB after China, India, Russian Federation, and Pakistan in terms of absolute numbers [5]. 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.
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