329. Latent Tuberculosis Infection (LTBI) among Healthcare Workers (HCWs): 10 Years of Experience at Memorial Sloan Kettering Cancer Center (MSK)
Session: Poster Abstract Session: HAI: Occupational Health
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • poster#329.pdf (676.1 kB)
  • Background: The risk of infection with Mycobacterium tuberculosis among HCWs is estimated to be higher than the US-born non-HCW population. Evaluation for and treatment of LTBI in HCWs is a standard occupational health practice in US healthcare facilities. However, HCW acceptance and compliance with available LTBI treatment regimens has been problematic.  Recently, regimens have become available that might improve HCW acceptance and compliance with the treatment of LTBI.

    Methods: A retrospective review of the records of all MSK HCWs diagnosed with LTBI between January 1, 2005 and December 31, 2014 was conducted.  HCWs were identified as having LTBI through MSK’s routine Pre-Placement Evaluation and annual TB screening processes.  LTBI was diagnosed in HCWs using the TST, and, starting in 2007, IGRA testing was used exclusively among TST-positive HCWs with a history of having received BCG vaccine. HCWs diagnosed with LTBI were offered the choice of 4 regimens as these options became available over the years of the study: 9 months of daily INH alone; 4 months of daily rifampin alone; 3 months of once weekly rifapentine/INH (R/I); or no treatment.  These regimens were not always started in the same year that LTBI was diagnosed.  Medication was provided to HCWs from the MSK pharmacy without charge.  IRB approval for this study was obtained. Comparison of the different regimens was evaluated using the Fisher’s exact test.

    Results: Over 10 years, 930 HCWs were diagnosed with LTBI at MSK.   Overall, 357 (38.4%) accepted treatment for LTBI, and 273 (76.5%) completed the regimen they started. Of these 357, 202 (56.6%) chose INH and 141 (69.8%) completed; 104 (29.1%) chose rifampin and 87 (83.6%) completed;  and 51 (14.3%) chose R/I and 45 (88.2%) completed.  HCWs were significantly more likely to have completed treatment with either rifampin or R/I than INH (p = 0.0086; p = 0.0074, respectively). There was no statistically significant difference between completion of rifampin and R/I.

    Conclusion: These results suggest that HCWs are more likely to complete either rifampin or R/I for the treatment of LTBI than INH. Thus, consideration should be given to no longer routinely recommend INH for the treatment of LTBI in HCWs.   Additional awareness and usage of these two alternative regimens may also improve HCW acceptance of treatment of LTBI.

    Esther Arguello Perez, MD1, Cynthia Eisenstein, RN, COHN2, William J. Schneider, MD, MPH2, Maria Del Castillo Garcia, MD1, Sherard N.J. Lacaille, MBBS3, Anabella Lucca Bianchi, MD1, Sejal M. Morjaria, MD1, Fabian Andres Romero, MD1, Sulin Low, RN, COHN2, Violet Fitzpatrick, RN, COHN2, Susan K. Seo, MD1,4 and Arthur E. Brown, MD, FIDSA, FSHEA1,2,4, (1)Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, (2)Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, NY, (3)Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, (4)Department of Medicine, Weill Cornell Medical College, New York, NY

    Disclosures:

    E. Arguello Perez, None

    C. Eisenstein, None

    W. J. Schneider, None

    M. Del Castillo Garcia, None

    S. N. J. Lacaille, None

    A. Lucca Bianchi, None

    S. M. Morjaria, None

    F. A. Romero, None

    S. Low, None

    V. Fitzpatrick, None

    S. K. Seo, None

    A. E. Brown, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.