Source: Annual Congress 2010 - Multidrug-resistant and extensively drug-resistant tuberculosis
Disease area: Respiratory infections

Abstract

Nosocomial transmission of multidrug-resistant tuberculosis (MDR TB) was a serious health problem in Latvia from 1999 to 2001. Since that time, TB infection control plans for health care facilities and ambulatory treatment were enforced, providing improvement.
Objective. To detect the proportion of TB cases attributable to recent transmission, and identify high-risk venues.
Methods. We conducted a prospective cohort study by selecting all M.tuberculosis cultures from TB cases diagnosed in Riga city and district from Nov. 2007 to Oct 2009. Drug sensitivity testing (DST) and genotyping of isolates were performed. We defined clusters as two or more cases with isolates with identical IS6110-RFLP and spoligotyping patterns. Interviews, data abstractions and cluster analysis were performed for clustered TB cases.
Results. 649 TB cases were tested, of whom 299 clustered (46%) in 60 clusters. Cluster analysis was done for 97 patients (17 dead, 6 refused), showing several possible linkages.

Characteristics of cluster investigation.

Type of contact	Description of link	DST	Pairs in clusters
Household	Family	S	6
Nosocomial	Hospital (unlikely)	DR	1
Nosocomial	Hospital, prison (both unlikely)	MDR	2
Social	Shelter, acquaintance, siblings	S	11
Social	Church	DR	1
Social	Neighbors, bars, born abroad	MDR	3

S-sensitive, MDR-multidrug-resistant, DR-drug-resistant, non-MDR

Laboratory and bronchoscopic-related contamination was suspected for 8 cases in 4 clusters, 1.2 % of all cases.
Conclusions. We could not confirm recent nosocomial transmission of MDR TB in our study, but the spread of sensitive strains in shelters and MDR M.tuberculosis strains in social contacts was identified.

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A. Nodieva, I. Pole, L. Cesniece, V. Riekstina, A. Kosevacka, Z. Konosenoka, A. Toma, V. Skripconoka, G. Skenders, V. Zvigure, A. Lipska, I. Bruse, R. Deklava, I. Gravite, I. Leskevica, P. Moonan, K. Ijaz, V. Leimane, T. Holtz (Riga, Latvia; Atlanta, United States Of America). Epidemiological links and laboratory contamination among clustered TB cases in Riga City and district. Eur Respir J 2010; 36: Suppl. 54, 352

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