Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review.
Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review.
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DOI：
10.1093/cid/ciaa720
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发表时间：
2021-01-23
期刊：
影响因子：
--
通讯作者：
Fielding KL
中科院分区：
文献类型：
--
作者：
Karat AS;Gregg M;Barton HE;Calderon M;Ellis J;Falconer J;Govender I;Harris RC;Tlali M;Moore DAJ;Fielding KL
感染预防和控制（IPC）措施减少结核分枝杆菌（MTB）在卫生设施中传播的证据有限。这项系统性综述是世界卫生组织委托进行的7项系统性综述之一，旨在为2019年全球结核病（TB）IPC指南更新提供信息，该综述提出了以下问题：结核病的分诊和/或隔离和/或有效治疗是否会减少医疗机构中的MTB传播？在纳入的25篇文章中，19篇报告了医务工作者（HCW;绝对风险降低1%-21%）中的潜伏性TB感染（LTBI）发生率; 5篇报告了HCW中的TB疾病发生率（无/轻微[高TB负担]或中度[低负担]降低），2篇报告了人类免疫缺陷病毒阳性住院患者（降低6%-29%）。总体而言，25项研究中有23项实施了多种IPC措施;无法分列各项措施的影响。一揽子IPC措施似乎减少了MTB的传播，但分诊、隔离或有效治疗（单独或联合）的有效性证据是间接和低质量的。统一研究设计和报告框架将有助于进行正式的数据综合，并促进决策。发现25篇文章，大多数研究表明，实施一揽子干预措施后，潜伏性结核感染或结核病发病率降低，但证据不足，个别干预措施的有效性。我们对未来的研究提出建议，以提供更好的证据基础。
Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, 1 of 7 commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in healthcare settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in healthcare workers (HCWs; absolute risk reductions 1%–21%); 5 reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and 2 in human immunodeficiency virus-positive in-patients (6%–29% reduction). In total, 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonizing study designs and reporting frameworks will permit formal data syntheses and facilitate policy making. Twenty-five articles were found. Most studies showed reduced latent tuberculosis infection or tuberculosis disease incidence after implementation of an intervention package, but evidence was weak for effectiveness of individual interventions. We make recommendations for future research to provide a better evidence base.
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