Laboratory-acquired infection in clinical laboratories and the incidence rate after Brucella exposure risk events: a systematic review and meta-analysis

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-10-18 DOI:10.1016/j.jhin.2024.10.004

M. Wang , W. Sun , C. Zhou , S. Wang , Q. Shi , J. Lin , H. Mi , B. Hu , J. Pan , X. Gao

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Abstract

Background

Personnel in clinical microbiology laboratories face heightened risks of occupational infections, due to the potential for pathogenicity in clinical samples.

Aim

To summarize the characteristics of laboratory-acquired infections (LAIs) and review exposure incidents in clinical laboratories, and to conduct a meta-analysis to estimate post-exposure incidence rates and evaluate the efficacy of post-exposure prophylaxis (PEP) following Brucella exposures.

Methods

A systematic search across PubMed, Embase, Web of Science, CNKI, Wanfang, CMB, and the ABSA LAI database extracted relevant literature published from January 1^st, 1990, to August 31^st, 2023, including case reports and laboratory exposure risk events. Negative-binomial regression was used to estimate the relative increase in reported numbers per year of LAIs. Meta-analysis was performed to estimate the incidence rate (IR) of LAIs among exposed laboratory personnel after Brucella exposure risk events.

Findings

A total of 164 LAIs were reported in hospital laboratories. Negative-binomial regression analysis indicated no significant decline in annual LAIs reports (relative risk and 95% CI: 0.98 (0.97, 1.00); P = 0.052). The leading pathogens were Brucella spp. (55.5%), Neisseria meningitidis (7.3%), and Shigella sonnei (5.5%). The meta-analysis revealed that the incidence rate for Brucella-related LAIs among laboratory personnel was 60 per 100,000 laboratory personnel. Laboratory personnel exposed to high-risk Brucella incidents faced a notably elevated infection risk, estimated at 80 per 100,000 laboratory personnel. Compared with high-risk Brucella exposures with PEP, highrisk Brucella exposures without PEP had a 6.33-fold increase in the risk of Brucella infection.

Conclusions

Clinical laboratory personnel remain at infection risk, with no reduction in reported LAI cases, mainly resulting from Brucella acquisitions. PEP was shown to be effective against high-risk Brucella exposures.

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临床实验室中的实验室获得性感染和布鲁氏菌暴露风险事件后的发病率：系统回顾和荟萃分析。

背景：本研究旨在总结实验室获得性感染（LAI）的特点，并回顾临床实验室中的暴露事件。此外，还进行了一项荟萃分析，以估算暴露后的发病率并评估布鲁氏菌暴露后预防（PEP）的疗效：方法：对PubMed、Embase、Web of Science、CNKI、Wanfang、CMB和ABSA LAI数据库等数据库进行了系统检索，以提取1990年1月1日至2023年8月31日期间发表的相关文献。其中包括临床实验室的病例报告和实验室暴露风险事件。采用负二叉回归法估算每年 LAI 报告数量的相对增长。进行了一项荟萃分析，以估算布鲁氏菌暴露风险事件后实验室暴露人员的LAI发病率（IR）：医院实验室共报告了 164 例 LAI。负二项式回归分析表明，每年的LAI报告数量没有显著下降（相对风险和95% CI：0.9834 [0.9667,1.0001]，P值：0.052）。大多数 LAI（68.3%）发生在日常工作中，只有 9.8% 与实验室意外接触有关。主要病原体是布鲁氏菌（55.5%）、脑膜炎奈瑟菌（7.3%）和宋内志贺氏菌（5.5%）。发展中国家由布鲁氏杆菌引起的 LAI 比例高于发达国家（72.4% 对 48.7%）。荟萃分析显示，实验室人员中与布鲁氏菌相关的 LAI 发病率为每 10 万名实验室人员中 60 例。接触高风险布鲁氏菌事件的实验室人员面临的感染风险明显升高，估计为每10万名实验室人员中有80人感染。在较高风险的布鲁氏菌感染事件中，未接受 PEP 的实验室人员的感染风险是接受 PEP 的实验室人员的 6.33 倍。与未接受 PEP 相关的可归因比例为 84.2%：结论：临床实验室人员仍然面临感染风险，报告的 LAI 病例并未减少，主要是由于感染了布鲁氏菌。事实证明，PEP 对高风险的布鲁氏菌暴露有效。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.