TREATMENT OUTCOMES OF MDR-TB AND REFERRAL NETWORKS IN AN OUT-PATIENT PRIVATE-INITIATED PROGRAMMATIC MANAGEMENT FOR DRUG RESISTANT TUBERCULOSIS (PMDT) FACILITY

Background and Aims: Tuberculosis (TB) disease among healthcare workers (HCWs) highly impacts morbidity and TB transmission in a healthcare setting. We describe the clinical and microbiological characteristics and treatment outcomes of TB in HCWs. Methods: A retrospective cohort study of TB in HCWs from a registered database during 2003 to 2016 at Chiang Mai University Hospital. Outcomes at the end of the treatment were evaluated. Results: Seventy-eight cases of HCWs, 56 nurses (71.8%), 12 physicians (15.4%), and 10 paramedics (12.8%), were diagnosed as TB disease. Female: male ratio of 52:48, mean age of 37.0 14.0 years, median work duration of 12.0 years and body mass index of 19.4 2.5 kg/m. Numbers of TB cases, categorized by working place, were 28 (33.9%) in Medical department, 12 (15.4%) in out-patient department/emergency room (OPD/ER) and 11 (14.1%) in Surgical department. Pulmonary TB (PTB) is the most common (89.7%) manifestation of TB in HCWs, followed by extra-pulmonary TB (7.7%) and combined pulmonary and extrapulmonary TB (2.6%). Although 60.3% were symptomatic, 39.7% had sub-clinical TB. The sputum acid-fast stains were positive in 30 (41.7%) HCWs with PTB. Cultures were positive in 27 (34.7%) cases, 92.6% was M.tuberculosis. Drug sensitivity patterns showed drug-sensitive TB of 76%, resistance to any one 1line drug of 19.2%, and multidrug-resistant TB (MDR-TB) of 3.7%. All of the Drug-resistant TB cases had never been treated for TB before.Success rate of treatment was 100% (46.1% cure and 53.9% complete treatment) in 76 evaluable cases. None of them relapsed. Conclusion: Our results indicate that HCWs are a high risk group for TB disease. Primary MDR-TB can be found in HCWs, which indicates hospital transmission of tuberculosis. Annual active TB screening in HCWs will enable early detection and treatment for improving outcomes. TB control guidelines should be strictly implemented to prevent TB transmission in healthcare setting.