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      Primary Multidrug‐resistant Tuberculosis in a Surgeon Secondary to a Needlestick Injury: A Neglected Problem

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          Abstract

          Healthcare workers (HCWs) are highly at risk for tuberculosis (TB) exposure, particularly those in high TB burden countries. Inoculation TB secondary to needlestick injury is uncommon but can occur in HCWs. Herein, we report an unusual case of primary multidrug‐resistant tuberculosis (MDR-TB) in a surgeon secondary to a needlestick injury while performing thoracentesis on a TB patient, and the surgeon recovered and returned to work after 22 months of anti-TB treatment. We searched the PubMed database and identified 19 cases of inoculation TB secondary to sharp injury in HCWs including the present case. Those cases highlight that primary inoculation of TB even MDR-TB infection should not be neglected in patients suffered needlestick injury when the sharp instrument suspected or confirmed contaminated with TB. In this situation, if the HCWs need for additional protection or prophylactic anti-TB is worthy of further study.

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          Most cited references27

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          Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017

          Yu Pang, Jun An, Wei Shu … (2019)
          We investigated the epidemiology of extrapulmonary tuberculosis (TB) among patients admitted to Beijing Chest Hospital, Beijing, China, during January 2008–December 2017. Of 19,279 hospitalized TB patients, 33.4% (6,433) had extrapulmonary TB and 66.6% (12,846) had pulmonary TB. The most frequent forms of extrapulmonary TB observed were skeletal TB (41.1%) and pleural TB (26.0%). Younger, female patients from rural areas were more likely to have extrapulmonary TB. However, patients with diabetes mellitus were less likely to have extrapulmonary TB compared with patients without diabetes. A higher proportion of multidrug-resistant (MDR) TB was observed among patients with extrapulmonary TB than among patients with pulmonary TB. We observed a large increase in MDR TB, from 17.3% to 35.7%, for pleural TB cases. The increasing rate of drug resistance among extrapulmonary TB cases highlights the need for drug susceptibility testing and the formulation of more effective regimens for extrapulmonary TB treatment.
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            Global tuberculosis report 2020

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              Prevalence of and risk factors for tuberculosis among healthcare workers in Chinese tuberculosis facilities

              Xiao-Ning Wang, Tian-Lun He, Meng-Jie Geng … (2018)
              Background China is one of 22 countries with a high tuberculosis (TB) burden in the world. Healthcare workers (HCWs) have a high risk of contracting Mycobacterium tuberculosis infection due to insufficient infection control practices. We conducted a cross-sectional study to explore the prevalence of TB and its associated risk factors among HCWs in Chinese TB facilities. Methods Two hundred and forty-one TB facilities employing a total of 9663 HCWs were selected from 12 provinces in China to represent healthcare settings at the provincial, prefectural, and county levels. Structured questionnaires were used to collect information on TB infection control practices and HCWs in those facilities. Data was double entered into EpiData 3.1; TB prevalence and associated risk factors were analyzed using SPSS 21.0 with bivariate and multivariate regression models. Results The results showed that 71 HCWs had been diagnosed with TB, accounting for a prevalence of 760/100 000. The multivariate analysis showed that associated risk factors included belonging to the age group of 51 years and above (aOR: 6.17, 95% CI: 1.35–28.28), being a nurse (aOR = 3.09, 95% CI: 1.15–8.32), implementation of 0–9 items of management measures (aOR = 2.57, 95% CI: 1.37–4.80), and implementation of 0–1 items of ventilation measures (aOR = 2.42, 95% CI: 1.31–4.47). Conclusion This was the first national large sampling survey on TB prevalence among HCWs in China. It was found that the implementation of TB infection control practices in some facilities was poor. The TB prevalence in HCWs was higher than that in the general population. Therefore, TB infection control practices in Chinese medical facilities should be strengthened. Electronic supplementary material The online version of this article (10.1186/s40249-018-0407-6) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Drug Resist
                Journal ID (iso-abbrev): Infect Drug Resist
                Journal ID (publisher-id): idr
                Title: Infection and Drug Resistance
                Publisher: Dove
                ISSN (Electronic): 1178-6973
                Publication date (Electronic): 14 November 2022
                Publication date Collection: 2022
                Volume: 15
                Pages: 6651-6657
                Affiliations
                [1 ]State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang Province, People’s Republic of China
                [2 ]Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences , Hangzhou, Zhejiang Province, People’s Republic of China
                [3 ]Nursing Department, the First Affiliated Hospital, Zhejiang University School of Medicine , Hangzhou, Zhejiang Province, People’s Republic of China
                Author notes
                Correspondence: Jie Wang, Email 1195040@zju.edu.cn
                [*]

                These authors contributed equally to this work

                Article
                Publisher ID: 387363
                DOI: 10.2147/IDR.S387363
                PMC ID: 9673929
                PubMed ID: 36406864
                SO-VID: 1386c6d5-b782-4139-8208-bf7e65774d31
                Copyright © © 2022 Yang et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 24 August 2022
                Date accepted : 08 November 2022
                Page count
                Figures: 2, Tables: 1, References: 27, Pages: 7
                Funding
                Funded by: CAMS Innovation Fund for Medical Sciences;
                Funded by: the Fundamental Research Funds for the Central Universities, China;
                This study was supported by CAMS Innovation Fund for Medical Sciences (2019-I2M-5-045) and the Fundamental Research Funds for the Central Universities, China (Grant No. 2022ZFJH003).
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cutaneous tuberculosis,tubercular tenosynovitis,inoculation tuberculosis,occupational exposure
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cutaneous tuberculosis, tubercular tenosynovitis, inoculation tuberculosis, occupational exposure

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