High Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers

Abstract

Background-Nosocomial transmission has been described in extensively drug resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about rates of drug-resistant TB among healthcare workers (HCWs) in TB and HIV endemic settings.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…The availability of newer drugs, such as bedaquiline and delamanid, [3][4][5] has not averted this problem and resistance to both bedaquiline and delamanid in the same patient has already been reported. 6 The effect on patients is profound, because drug resistant tuberculosis is associated with a higher morbidity than drug-sensitive tuberculosis 7 and is responsible for approximately 20% of the global tuberculosis mortality, with mortality rates estimated at around 40% for patients with MDR tuberculosis and 60% for those with XDR tuberculosis. 1 Provision of effective first-line treatment was hoped to prevent the emergence of drug-resistant tuberculosis as a public health problem.…”

“…Drug-resistant tuberculosis causes a strain on health systems because of the chronic nature of the disease, and because of the risk of transmission to health-care workers. 7 Drug-resistant tuberculosis also jeopardises tuberculosis control through its economic effect, because the high cost of managing drug-resistant tuberculosis is not sustainable in some settings and an anticipated shortfall in global resources has been reported by the STOP TB partnership. 1 In the USA, average inpatient costs have been estimated to be US$81 000 for patients with MDR tuberculosis and $285 000 for those with XDR tuberculosis.…”

Multi-drug resistant tuberculosis and HIV-infection

“…Таким образом, медицинский персонал больниц подвержен более высокому риску заражения ШЛУ туберкулезом, что обусловлено характером профес сиональной деятельности [40].…”

“…Соотношение ВИЧ инфицированных практически не отличалось (55 % vs 57 %). Однако среди ВИЧ ин фицированного медицинского персонала противо вирусную терапию получали 63 % vs 47 % пациентов (различие достоверно, p < 0,001).Таким образом, медицинский персонал больниц подвержен более высокому риску заражения ШЛУ туберкулезом, что обусловлено характером профес сиональной деятельности [40]. …”

Better treatment of XDR tuberculosis needed in South Africa

“…The complications of adhesiolysis during reoperation are correlated to the extent and severity of adhesion formation. 4 Thus, although the use of adhesion reducing agents might not completely prevent adhesion formation in operations with extensive peritoneal damage and have only a modest effect on the incidence of small bowel obstruction, reducing the extent and severity of adhesions is likely to have a benefi cial effect on the outcomes of future operations.…”