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Abstract：
Introduction Latent tuberculosis infection (LTBI) is an enormous reservoir for tuberculosis (TB), and healthcare workers (HCWs) are at high risk for TB infection. QuantiFERON-TB Gold Plus (QFT-Plus) is an alternative to the tuberculin skin test for LTBI detection, but data on its application and LTBI detected by QFT-Plus in high TB burden countries are limited. This study aimed to determine the prevalence of LTBI and its risk factors, and to investigate the QFT-Plus results in Thai HCWs. Methods A cross-sectional analytical study was conducted among HCWs at a secondary care hospital in Health Region 5, Thailand. Eligible HCWs were enrolled and underwent QFT-Plus testing. Interferon-gamma (IFN-γ) values in tubes were analysed. The prevalence and associated risk factors for LTBI were assessed based on laboratory and sociodemographic data. Logistic regression analyses were applied to calculate odds ratios (OR, aOR) reported with 95% confidence intervals (CI). Results Of the 269 participants enrolled, their median age was 42 years and 93.31% (n = 251/269) were female. The majority (n = 178/269, 66.17%) were nurses or nurse assistants and 42.75% (n = 115/269) worked in the inpatient medical wards. Overall, the QFT-Plus results showed 110 (40.89%) positive with good agreement (93.68%; κ 0.87) and high correlation (Spearman\'s ρ 0.91) of IFN-γ concentrations in the two antigen tubes. A true difference in IFN-γ values for predicting a recent infection was found about 7.81% (n = 21/269). By univariate and multivariate analyses, the participants\' age > 40 years (OR = 3.21, 95% CI: 1.84-5.64%; aOR = 2.05, 95% CI: 1.07-3.96%), and employment duration > 10 years (OR = 3.19, 95% CI: 1.66-6.37%; aOR = 2.34, 95% CI: 1.05-5.21%) were significantly associated with the increased risk of LTBI (p-value < 0.05). Conclusions The prevalence of LTBI among these HCWs was high, and the increased risk factors for LTBI according to QFT-Plus positivity were age over 40 years and working time in the hospital for more than 10 years. It is important to screen HCWs in this setting for LTBI, particularly those with long employment durations and older ages. The high prevalence of LTBI suggests that LTBI management, such as regular screening and treatment, should be considered together with strengthening preventive measures, especially in high-risk groups.
摘要：
简介潜在结核病感染（LTBI）是结核病（TB）的巨大水库，和医护人员（HCWs）感染结核病的风险很高。QuantiFERON-TBGoldPlus（QFT-Plus）是用于LTBI检测的结核菌素皮肤测试的替代品，但QFT-Plus在高结核病负担国家检测到的关于其应用和LTBI的数据有限。本研究旨在确定LTBI的患病率及其危险因素，并调查泰国HCWs的QFT-Plus结果。方法对泰国卫生区5的二级保健医院的医护人员进行了横断面分析研究。纳入符合条件的HCWs并接受QFT-Plus测试。分析管中的干扰素-γ(IFN-γ)值。根据实验室和社会人口统计学数据评估LTBI的患病率和相关危险因素。采用Logistic回归分析计算比值比(OR，OR)以95%置信区间(CI)报告。结果在269名参与者中，他们的中位年龄为42岁,93.31%(n=251/269)为女性.大多数（n=178/269，66.17％）是护士或护士助理，而42.75％（n=115/269）在住院医疗病房工作。总的来说,QFT-Plus结果显示110（40.89%）阳性，两个抗原管中的IFN-γ浓度具有良好的一致性（93.68%；κ0.87）和高度相关性（Spearmanρ0.91）。预测近期感染的IFN-γ值的真实差异约为7.81％（n=21/269）。通过单变量和多变量分析，参与者年龄>40岁（OR=3.21，95%CI：1.84-5.64%；aOR=2.05，95%CI：1.07-3.96%），和就业时间>10年（OR=3.19，95％CI：1.66-6.37％；aOR=2.34，95％CI：1.05-5.21％）与LTBI风险增加显着相关（p值<0.05）。结论LTBI在这些HCWs中的患病率很高，根据QFT-Plus阳性，LTBI增加的危险因素是年龄超过40岁，在医院工作时间超过10年。在LTBI的此设置中筛选HCW非常重要，特别是那些工作时间长、年龄较大的人。LTBI的高患病率表明，LTBI管理，例如定期筛查和治疗，应与加强预防措施一起考虑，尤其是高危人群。
