Infect Chemother.  2019 Dec;51(4):355-364. 10.3947/ic.2019.51.4.355.

Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers at a Referral Hospital in Korea

• Park SY
• Lee E
• Lee EJ
• Kim TH
• Kim YK

• KMID: 2466468
• DOI: http://doi.org/10.3947/ic.2019.51.4.355

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.

Keyword

Adverse drug reaction; Isoniazid; Rifampin; Latent tuberculosis infection

MeSH Terms

Anaphylaxis
Delivery of Health Care*
Drug-Related Side Effects and Adverse Reactions
Humans
Interferon-gamma Release Tests
Isoniazid
Korea*
Latent Tuberculosis*
Mass Screening*
Platelet Count
Referral and Consultation*
Retrospective Studies
Rifampin
Thrombocytopenia
Tuberculosis
Isoniazid
Rifampin

Figure

• 

  Figure 1 Study flow diagram. IGRA, interferon-gamma release assay; PA, posteroanterior view; TB, tuberculosis; TST, tuberculin skin test; LTBI, latent tuberculosis infection; 3HR, 3-month isoniazid/rifampin regimen; 4R, 4-month rifampin regimen; 9H, 9-month isoniazid regimen.

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