Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers at a Referral Hospital in Koreaopen access
- Authors
- Park, Se Yoon; Lee, Eunyoung; Lee, Eun Jung; Kim, Tae Hyong; Kim, Yang-Ki
- Issue Date
- Dec-2019
- Publisher
- Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy
- Keywords
- Adverse drug reaction; Isoniazid; Rifampin; Latent tuberculosis infection
- Citation
- Infection and Chemotherapy, v.51, no.4, pp 355 - 364
- Pages
- 10
- Journal Title
- Infection and Chemotherapy
- Volume
- 51
- Number
- 4
- Start Page
- 355
- End Page
- 364
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/3835
- DOI
- 10.3947/ic.2019.51.4.355
- ISSN
- 2093-2340
2092-6448
- Abstract
- Background: Healthcare workers (HCWs) have a high risk of tuberculosis (TB) infection. Since August 2017, Korea has mandated the testing of latent TB infection (LTBI) and recommended treatment from HCWs at medical institutions. However, the acceptance/completion rate and adverse events of LTBI treatment have not been analyzed. Materials and Methods: From February to August 2017, we conducted a retrospective study at a referral university hospital in Korea, to screen the interferon-gamma release assay (IGRA) tests conducted for all HCWs for detecting and treating LTBI. HCWs diagnosed with LTBI were offered a 9-month isoniazid (9H), 3-month isoniazid/rifampin (3HR), or 4-month rifampin regimen. We investigated the acceptance/completion rate, adverse events, and causes of discontinuation or change in LTBI medication. A major adverse event was one wherein a patient had any adverse event >= grade 3 causing LTBI treatment interruption. Results: Of the 1,538 HCWs, 1,379 underwent IGRA testing for LTBI. Among them, 13.6% (187/1,379) tested positive and 73.3% (137/187) received treatment. The overall completion rate was 97.8% (134/137). HCWs were significantly more likely to complete first-line therapy with 3HR than with 9H (91.4% vs. 76.7%, P = 0.02). The most common major adverse event was hepatotoxicity (n = 7), followed by thrombocytopenia (n = 1) and anaphylactic shock (n = 1). Hepatotoxicity and hepatotoxicity (>= grade 2) were more frequent in 9H than in 3HR (39.5% vs. 17.2%, P = 0.006 and 18.6% vs. 3.7%, P = 0.005, respectively). The median time to hepatotoxicity was 96 days (interquartile range, 20 - 103 days). Conclusion: Completion of first-line therapy for LTBI is more likely with 3HR than with 9H. This might be related to the development of hepatotoxicity after around 3 months of treatment. Anaphylactic shock and platelet count should be carefully monitored in those receiving rifampin-containing regimens.
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