拉丁美洲和加勒比地区医护人员潜伏性结核感染（LTBI）的患病率：系统评价与荟萃分析
Prevalence of latent tuberculosis infection (LTBI) in healthcare workers in Latin America and the Caribbean: systematic review and meta-analysis.
作者信息
Meregildo-Rodriguez Edinson Dante, Ortiz-Pizarro Mariano, Asmat-Rubio Martha Genara, Rojas-Benites Mayra Janett, Vásquez-Tirado Gustavo Adolfo
机构信息
Escuela de Medicina, Universidad César Vallejo, Trujillo, Perú.
Infectious and Communicable Diseases Research Group (ICDRG), Universidad César Vallejo, Trujillo, Perú.
出版信息
Infez Med. 2024 Sep 1;32(3):292-311. doi: 10.53854/liim-3203-4. eCollection 2024.
BACKGROUND
Tuberculosis remains a significant global health concern, and healthcare workers (HCWs) face a high risk of acquiring latent tuberculosis infection (LTBI) through occupational exposure. In the Latin American and Caribbean (LAC) region, where the burden of tuberculosis is substantial, understanding the prevalence of LTBI among HCWs is crucial for effective infection control measures. Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence of LTBI among HCWs in LAC countries.
METHODS
Our search included MEDLINE, Scopus, EMBASE, Web of Science, and Google Scholar databases, focusing on relevant English-language records. We looked for observational studies from inception until December 2023.
RESULTS
Our analysis included 38 studies representing 15,236 HCWs and 6,728 LTBI cases. These studies spanned the period from 1994 to 2023 and were conducted in Brazil, Peru, Cuba, Colombia, Trinidad and Tobago, Mexico, and Chile. The mean prevalence of LTBI among HCWs was 35.32% (range 17.86-56.00%) for interferon-gamma release assay (IGRA) and 43.67% (range 6.68-70.29%) for tuberculin skin test (TST). The pooled prevalence of LTBI among HCWs was 34.5% (95% CI 25.4-44.1%) for IGRA and 43.0% (95% CI 35.5-50.7%) for TST. When considering both IGRA and TST tests, the overall prevalence of LTBI among HCWs was 40.98% (95% CI 34.77-47.33%). LTBI was associated with longer lengths of employment and exposure to patients, family members, or any person with TB. Additionally, older HCWs faced a higher risk of LTBI. Specific professional roles (such as nurses, nurse technicians, or physicians), smoking, and deficient TB infection control measures increased the likelihood of LTBI. However, information regarding gender and BCG vaccination status showed discordance among studies.
CONCLUSION
Our findings underscore a substantial burden of LTBI among HCWs in LAC countries. Implementing adequate infection control measures is essential to prevent and control transmission within healthcare settings.
背景
结核病仍然是全球重大的健康问题，医护人员（HCWs）面临因职业暴露而感染潜伏性结核感染（LTBI）的高风险。在结核病负担较重的拉丁美洲和加勒比（LAC）地区，了解医护人员中LTBI的患病率对于有效的感染控制措施至关重要。因此，我们进行了一项系统评价和荟萃分析，以估计LAC国家医护人员中LTBI的患病率。
方法
我们的检索包括MEDLINE、Scopus、EMBASE、Web of Science和谷歌学术数据库，重点关注相关的英文记录。我们查找了从开始到2023年12月的观察性研究。
结果
我们的分析纳入了38项研究，涉及15236名医护人员和6728例LTBI病例。这些研究涵盖了1994年至2023年期间，在巴西、秘鲁、古巴、哥伦比亚、特立尼达和多巴哥、墨西哥以及智利进行。医护人员中LTBI的平均患病率，干扰素-γ释放试验（IGRA）为35.32%（范围17.86 - 56.00%），结核菌素皮肤试验（TST）为43.67%（范围6.68 - 70.29%）。医护人员中LTBI的合并患病率，IGRA为34.5%（95%置信区间25.4 - 44.1%），TST为43.0%（95%置信区间35.5 - 50.7%）。当同时考虑IGRA和TST检测时，医护人员中LTBI的总体患病率为40.98%（95%置信区间34.77 - 47.33%）。LTBI与工作年限较长以及接触患者、家庭成员或任何结核病患者有关。此外，年长的医护人员面临更高的LTBI风险。特定的职业角色（如护士、护士技术员或医生）、吸烟以及结核病感染控制措施不足会增加LTBI的可能性。然而，关于性别和卡介苗接种状况的信息在各研究中存在不一致。
结论
我们的研究结果强调了LAC国家医护人员中LTBI的沉重负担。实施适当的感染控制措施对于预防和控制医疗机构内的传播至关重要。
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