Abstract：
Healthcare facilities are a well-known high-risk environment for transmission of M. tuberculosis, the etiologic agent of tuberculosis (TB) disease. However, the link between M. tuberculosis transmission in healthcare facilities and its role in the general TB epidemic is unknown. We estimated the proportion of overall TB transmission in the general population attributable to healthcare facilities.
We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with M. tuberculosis isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities.
In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%-8% of transmission may be attributable to healthcare facilities.
Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB.
We combined data from a prospective, population-based molecular epidemiologic study with a universal electronic medical record (EMR) covering all healthcare facilities in Botswana to identify biologically plausible transmission events occurring at the healthcare facility. Patients with M. tuberculosis isolates of the same genotype visiting the same facility concurrently were considered an overlapping event. We then used TB diagnosis and treatment data to categorize overlapping events into biologically plausible definitions. We calculated the proportion of overall TB cases in the cohort that could be attributable to healthcare facilities.
In total, 1,881 participants had TB genotypic and EMR data suitable for analysis, resulting in 46,853 clinical encounters at 338 healthcare facilities. We identified 326 unique overlapping events involving 370 individual patients; 91 (5%) had biologic plausibility for transmission occurring at a healthcare facility. A sensitivity analysis estimated that 3%-8% of transmission may be attributable to healthcare facilities.
Although effective interventions are critical in reducing individual risk for healthcare workers and patients at healthcare facilities, our findings suggest that development of targeted interventions aimed at community transmission may have a larger impact in reducing TB.
摘要：
医疗机构是众所周知的结核分枝杆菌传播的高风险环境，结核病（TB）疾病的病原体。然而,结核分枝杆菌在医疗机构中的传播与其在一般结核病流行中的作用之间的联系尚不清楚.我们估计了一般人群中归因于医疗机构的总体结核病传播比例。
我们结合了来自前瞻性的数据，基于人群的分子流行病学研究,使用涵盖博茨瓦纳所有医疗机构的通用电子病历(EMR),以确定医疗机构发生的生物学上合理的传播事件.同时访问同一设施的具有相同基因型的结核分枝杆菌分离株的患者被认为是重叠事件。然后，我们使用结核病诊断和治疗数据将重叠事件分类为生物学上合理的定义。我们计算了队列中可能归因于医疗机构的总体结核病例的比例。
总共，1881名参与者有适合分析的结核病基因型和EMR数据，在338个医疗机构进行了46,853次临床治疗。我们确定了326个独特的重叠事件，涉及370名患者；91（5％）具有在医疗机构传播的生物学合理性。敏感性分析估计，3％-8％的传播可能归因于医疗保健设施。
尽管有效的干预措施对于降低医护人员和医疗机构患者的个人风险至关重要，我们的研究结果表明,制定针对社区传播的针对性干预措施可能对减少结核病产生更大的影响.
我们结合了来自前瞻性的数据，基于人群的分子流行病学研究,使用涵盖博茨瓦纳所有医疗机构的通用电子病历(EMR),以确定医疗机构发生的生物学上合理的传播事件.同时访问同一设施的具有相同基因型的结核分枝杆菌分离株的患者被认为是重叠事件。然后，我们使用结核病诊断和治疗数据将重叠事件分类为生物学上合理的定义。我们计算了队列中可能归因于医疗机构的总体结核病例的比例。
总共，1881名参与者有适合分析的结核病基因型和EMR数据，在338个医疗机构进行了46,853次临床治疗。我们确定了326个独特的重叠事件，涉及370名患者；91（5％）具有在医疗机构传播的生物学合理性。敏感性分析估计，3％-8％的传播可能归因于医疗保健设施。
尽管有效的干预措施对于降低医护人员和医疗机构患者的个人风险至关重要，我们的研究结果表明,制定针对社区传播的针对性干预措施可能对减少结核病产生更大的影响.
