Drug-Resistant TB in Hospitals
Posted by pozlife on October 27, 2007
A few relatively inexpensive, simple practices in hospitals could cut the number of new extensively drug-resistant TB (XDR TB) cases by half, suggests a new study by South African and US researchers.
The study used for its model Tugela Ferry, where in 2006 XDR TB killed all but one of 53 infected patients in one of the earliest, largest clusters of the disease in South Africa. All were HIV co-infected, and most died within two weeks of diagnosis. More than two-thirds had visited the hospital before they became ill, suggesting hospital-based “transmission of XDR tuberculosis might be a driver of this epidemic,” the study said.
If no preventive measures were taken in Tugela Ferry, the study predicted 1,300 new XDR TB cases would emerge there by 2012. However, the combined use of masks, reduced hospitalization time, and shifting to outpatient care could cut new XDR TB cases by a third. Adding to these interventions – by improving natural ventilation; testing for drug resistance; testing for and treating HIV; and isolating TB patients – “could avert nearly half of XDR TB cases in Tugela Ferry over the next five years,” researchers said.
However, the involuntary confinement of XDR TB patients would increase any outbreak as it would discourage those infected from seeking treatment, the authors said.
In a related commentary, University of California epidemiologists Travis Porco and Wayne Getz endorsed the study’s proposals. However, stopping XDR TB is more than a local problem, they wrote. “Multidrug and extensive drug resistance are monsters of our own creation,” they wrote. Effective interventions for XDR TB control “are national and international responsibilities, and the world community ignores this message at great peril.”
The full report, “Prevention of Nosocomial Transmission of Extensively Drug-Resistant Tuberculosis in Rural South African District Hospitals: An Epidemiological Modeling Study,” and the commentary, “Controlling Extensively Drug-Resistant Tuberculosis,” were published in The Lancet (2007;370(9597):1500-1507 and 1464-1465, respectively).
[This summary provided by the CDC National Center for HIV, STD, and TB Prevention | Agence France Presse | Oct. 26, 2007 | Marlowe Hood]