title: Nosocomial transmission of Mycobacterium tuberculosis from an extrapulmonary site.
abstract: OBJECTIVE
  To assess the extent of nosocomial transmission and risk factors associated with tuberculin skin test (TST) conversions among healthcare workers (HCWs) exposed to a patient with genitourinary Mycobacterium tuberculosis.
  
  
  METHODS
  Retrospective cohort study of exposed HCWs.
  
  
  METHODS
  A 275-bed community hospital in Middle Tennessee.
  
  
  METHODS
  A total of 128 exposed HCWs and the index patient, who required drainage of a prostatic abscess and bilateral orchiectomy and expired after a 27-day hospitalization. Disseminated tuberculosis was diagnosed at autopsy.
  
  
  METHODS
  Contact tracing was performed on exposed HCWs. Logistic regression was used to identify independent risk factors associated with TST conversion.
  
  
  RESULTS
  A total of 128 HCWs were exposed to the index patient. There was no evidence of active pulmonary tuberculosis throughout the patient's hospitalization; TST conversions occurred only among HCWs who were exposed to the patient during or after his surgical procedures. A total of 12 (13%) of 95 exposed HCWs who were previously nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2 of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic regression, irrigation or packing of the surgical site was the only independent risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence interval, 1.2-67; P=.03).
  
  
  CONCLUSIONS
  Manipulation of infected tissues of the genitourinary tract can result in nosocomial transmission of tuberculosis.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: D'Agata
authors.forename: S
authors.initials: S
authors.lastname: Wise
authors.forename: A
authors.initials: A
authors.lastname: Stewart
authors.forename: L B
authors.initials: LB
authors.lastname: Lefkowitz
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D015331:Cohort Studies; D003428:Cross Infection; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014389:Tuberculosis, Male Genital / Q000382:microbiology / Q000635:transmission*; D014566:Urogenital System / Q000382:microbiology