1
|
Nascimento Silva S, Cota G, Souza KM, de Freitas MG, Carvalho JDP, Galvão EL. Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review. Trop Med Int Health 2024; 29:454-465. [PMID: 38648858 DOI: 10.1111/tmi.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
Collapse
Affiliation(s)
- Sarah Nascimento Silva
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Glaucia Cota
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Kathiaja Miranda Souza
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Marina Gonçalves de Freitas
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- SCMED, Brazilian Health Regulatory Agency, Brasilia, Brazil
| | - Janaína de Pina Carvalho
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia., Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| |
Collapse
|
2
|
Wong C, Ng SY, Tan SH. An accidental laboratory exposure to Brucella melitensis: the prospective post-exposure management and a detailed investigation into the nature of the exposure. J Med Microbiol 2020; 67:1012-1016. [PMID: 29846154 DOI: 10.1099/jmm.0.000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Our aim was to prospectively manage 22 Brucella-exposed individuals and identify the lapses in laboratory practices that lead to the exposure. The exposed individuals were risk-stratified, assessed for post-exposure prophylaxis (PEP), counselled to self-monitor symptoms and followed-up with three serology tests. Staff laboratory practices were recorded. Ten out of 13 high-risk individuals received PEP within 48 h of exposure. Compliance with PEP and serology monitoring was 90 and 96 %, respectively. No brucellosis cases were documented. A single handler manipulated the Brucella isolate on the open bench. Movement of the isolate was tracked in detail, highlighting various points of laboratory non-conformance. Early PEP intervention is effective in preventing acquired brucellosis. Our pragmatic post-exposure management achieved high PEP and serology compliance. We experience first-hand how regular staff engagement motivated PEP adherence and interval blood sampling attendance. The enforcement of practical strategies and safety practices was also implemented without compromising our laboratory processing times.
Collapse
Affiliation(s)
- C Wong
- Department of Microbiology, Laboratory Medicine, Changi General Hospital, Singapore
| | - S Y Ng
- Department of Microbiology, Laboratory Medicine, Changi General Hospital, Singapore
| | - S H Tan
- Department of Microbiology, Laboratory Medicine, Changi General Hospital, Singapore
| |
Collapse
|
3
|
Imported brucellosis: A case series and literature review. Travel Med Infect Dis 2016; 14:182-99. [PMID: 27185403 DOI: 10.1016/j.tmaid.2016.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/08/2016] [Accepted: 05/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Brucellosis is one of the main neglected zoonotic diseases. Several factors may contribute to the epidemiology of brucellosis. Imported cases, mainly in travellers but also in recently arrived immigrants, and cases associated with imported products, appear to be infrequently reported. METHODS Cases of brucellosis diagnosed at a referral unit for imported diseases in Europe were described and a review of the literature on imported cases and cases associated with contaminated imported products was performed. RESULTS Most imported cases were associated with traditional risk factors such as travel/consumption of unpasteurized dairy products in endemic countries. Cases associated with importation of food products or infected animals also occurred. Although a lower disease incidence of brucellosis has been reported in developed countries, a higher incidence may still occur in specific populations, as illustrated by cases in Hispanic patients in the USA and in Turkish immigrants in Germany. Imported brucellosis appears to present with similar protean manifestations and both classical and infrequent modes of acquisition are described, leading on occasions to mis-diagnoses and diagnostic delays. CONCLUSIONS Importation of Brucella spp. especially into non-endemic areas, or areas which have achieved recent control of both animal and human brucellosis, may have public health repercussions and timely recognition is essential.
Collapse
|
4
|
Castrodale LJ, Raczniak GA, Rudolph KM, Chikoyak L, Cox RS, Franklin TL, Traxler RM, Guerra M. A Case-Study of Implementation of Improved Strategies for Prevention of Laboratory-acquired Brucellosis. Saf Health Work 2015; 6:353-6. [PMID: 26929849 PMCID: PMC4682031 DOI: 10.1016/j.shaw.2015.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/01/2015] [Accepted: 07/21/2015] [Indexed: 11/26/2022] Open
Abstract
Background In 2012, the Alaska Section of Epidemiology investigated personnel potentially exposed to a Brucella suis isolate as it transited through three laboratories. Methods We summarize the first implementation of the United States Centers for Disease Control and Prevention 2013 revised recommendations for monitoring such exposures: (1) risk classification; (2) antimicrobial postexposure prophylaxis; (3) serologic monitoring; and (4) symptom surveillance. Results Over 30 people were assessed for exposure and subsequently monitored for development of illness. No cases of laboratory-associated brucellosis occurred. Changes were made to gaps in laboratory biosafety practices that had been identified in the investigation. Conclusion Achieving full compliance for the precise schedule of serologic monitoring was challenging and resource intensive for the laboratory performing testing. More refined exposure assessments could inform decision making for follow-up to maximize likelihood of detecting persons at risk while not overtaxing resources.
Collapse
Affiliation(s)
- Louisa J Castrodale
- Alaska Department of Health and Social Services, Division of Public Health, Anchorage, AK, USA
| | - Gregory A Raczniak
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - Karen M Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Zoonotic and Emerging Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
| | - Lori Chikoyak
- Yukon-Kuskokwim Delta Regional Hospital, Bethel, AK, USA
| | - Russell S Cox
- Yukon-Kuskokwim Delta Regional Hospital, Bethel, AK, USA
| | - Tricia L Franklin
- Alaska Department of Health and Social Services, Division of Public Health, Anchorage, AK, USA
| | - Rita M Traxler
- Division of High-consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, USA
| | - Marta Guerra
- Division of High-consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, USA
| |
Collapse
|
5
|
Biologically hazardous agents at work and efforts to protect workers' health: a review of recent reports. Saf Health Work 2014; 5:43-52. [PMID: 25180133 PMCID: PMC4147232 DOI: 10.1016/j.shaw.2014.03.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/25/2014] [Accepted: 03/29/2014] [Indexed: 11/24/2022] Open
Abstract
Because information on biological agents in the workplace is lacking, biological hazard analyses at the workplace to securely recognize the harmful factors with biological basis are desperately needed. This review concentrates on literatures published after 2010 that attempted to detect biological hazards to humans, especially workers, and the efforts to protect them against these factors. It is important to improve the current understanding of the health hazards caused by biological factors at the workplace. In addition, this review briefly describes these factors and provides some examples of their adverse health effects. It also reviews risk assessments, protection with personal protective equipment, prevention with training of workers, regulations, as well as vaccinations.
Collapse
|
6
|
Knudsen A, Kronborg G, Dahl Knudsen J, Lebech AM. Laboratory exposure to Brucella melitensis in Denmark: a prospective study. J Hosp Infect 2013; 85:237-9. [PMID: 24070633 DOI: 10.1016/j.jhin.2013.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/27/2013] [Indexed: 11/29/2022]
Abstract
Brucella species are a frequent cause of laboratory-acquired infections. This report describes the handling of a laboratory exposure of 17 laboratory staff members exposed to Brucella melitensis in a large microbiology laboratory in a brucella-non-endemic area. We followed the US Centers for Disease Control and Prevention guidelines, but, of 14 staff members classified as high-risk exposure, none accepted post-exposure prophylaxis. However, in a period of 6 months of follow-up, none of the exposed laboratory workers developed brucellosis and all obtained sera were negative for antibrucella antibodies. We therefore question the value of routine serological follow-up.
Collapse
Affiliation(s)
- A Knudsen
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark.
| | | | | | | |
Collapse
|
7
|
Burns DS, Bailey MS. Undifferentiated febrile illnesses in military personnel. J ROY ARMY MED CORPS 2013; 159:200-5. [DOI: 10.1136/jramc-2013-000118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
8
|
Parekh R, Shah R, Darko D, Khanna P. Brucellosis disguised as infective endocarditis in the returning traveller. JRSM SHORT REPORTS 2013; 4:12. [PMID: 23476733 PMCID: PMC3591687 DOI: 10.1177/2042533312472122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ravi Parekh
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rakhee Shah
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Daniel Darko
- North West London Hospitals NHS Trust, London, UK
| | - Priya Khanna
- North West London Hospitals NHS Trust, London, UK
| |
Collapse
|
9
|
Cooke RPD, Chisnall C. Laboratory exposures to brucella in the UK and Ireland. J Hosp Infect 2012; 82:218. [PMID: 22999641 DOI: 10.1016/j.jhin.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 07/12/2012] [Indexed: 11/30/2022]
|
10
|
Tsou TP, Mu JJ. Brucellosis: A neglected but existing threat to travelers and laboratory personnel in Taiwan. J Formos Med Assoc 2012; 111:353-4. [DOI: 10.1016/j.jfma.2012.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022] Open
|
11
|
Sayin-Kutlu S, Kutlu M, Ergonul O, Akalin S, Guven T, Demiroglu YZ, Acicbe O, Akova M. Laboratory-acquired brucellosis in Turkey. J Hosp Infect 2012; 80:326-30. [PMID: 22365915 DOI: 10.1016/j.jhin.2011.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 12/10/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laboratory healthcare workers (HCWs) are at risk of laboratory-acquired brucellosis (LAB). AIM To describe the risk factors of LAB among HCWs. METHODS A multicentre survey study was conducted by face-to-face interview in 38 hospitals from 17 provinces of Turkey. A structured survey was administered to the HCWs, working in infectious diseases clinics and microbiology departments, who were at risk of brucella infection. FINDINGS The survey response rate was 100%. Of the 667 laboratory workers, 38 (5.8%) had a history of LAB. In multivariate analysis, factors independently associated with an increased risk of LAB included working with the brucella bacteria (odds ratio: 5.12; 95% confidence interval: 2.28-11.52; P < 0.001) and male gender (2.14; 1.02-4.45; P = 0.042). Using a biosafety cabinet level 2 (0.13; 0.03-0.60; P = 0.009), full adherence to glove use (0.27; 0.11-0.65; P = 0.004) and longer duration of professional life (0.86; 0.80-0.92; P < 0.001) were found to be protective. CONCLUSIONS Working with the brucella bacteria, being male, a lack of compliance with personal protective equipment and biosafety cabinets were the independent risk factors for the development of LAB in our series. Increased adherence to personal protective equipment and use of biosafety cabinets should be priority targets to prevent LAB.
Collapse
Affiliation(s)
- S Sayin-Kutlu
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|