Helicobacter pylori infection in hospital workers over a 5-year period: correlation with demographic and clinical parameters.

BACKGROUND

We aimed to determine whether any of various groups of medical and nonmedical staff in a large acute care hospital were at increased risk of acquiring Helicobacter pylori infection over a 5-year period, and we also aimed to identify risk factors or symptoms related to H. pylori positivity and seroconversion.

METHODS

A total number of 437 subjects, aged 36.8 +/- 7.7 years (range, 23-60 years)-employees of our hospital-were tested by immunoassay for serum IgG antibodies against H. pylori. Subjects were assigned to four main groups: (I) nursing staff ( n = 249; aged 34.7 +/- 7 years); (II) administrative and technical staff ( n = 127; aged 39.2 +/- 8.1 years); (III) medical staff ( n = 31; aged 42.4 +/- 4.9 years); and (IV) paramedical staff (blood donor department) ( n = 30; aged 37.6 +/- 8.5 years). Differences in age and educational level between these four groups were statistically highly significant ( P < 0.0001). Each subject completed a questionnaire containing several clinical and demographic parameters. The same cohort of individuals was tested 5 years later.

RESULTS

The overall seroprevalence of H. pylori infection was 45.5%, and in each group (I, II, III, and IV) being 48.6%, 44.1%, 41.9%, and 30% respectively. Logistic regression analysis revealed that the risk of infection by H. pylori was significantly higher in group I compared with group II (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.04-3.52; P = 0.037). The H. pylori positivity increased with age: 40.6% for those aged 23-40 years and 57.5% for those aged 41-60 years ( P = 0.001). The level of education was inversely associated with H. pylori infection ( P = 0.001). During the 5-year observation, 59 of 238 (24.8%) subjects initially negative for H. pylori infection became positive, thus giving an annual seroconversion rate of 4.95%. Logistic regression analysis revealed that the seroconversion rate was significantly higher in group I compared with group II (28.1% vs 21.1%; OR, 2.34; 95% CI, 1.08-5.07; P = 0.03). The rate of seroconversion was higher in subjects aged 35-55 years compared with subjects aged 23-34 years (32% vs 17.5%; P= 0.009). Subjects who were positive for H. pylori infection in both examinations had a higher percentage of heartburn ( P = 0.029), regurgitation ( P = 0.023), and nausea ( P= 0.037) compared with those who were negative in both examinations. Differences between those who were continuously negative for H. pylori infection and those who seroconverted during the observation period were not significant.

CONCLUSIONS

In this longitudinal study of workers in a large acute care hospital in Greece it was found that nursing staff had a significantly higher risk of infection compared with administrative and technical staff. Age was significantly positively related both to H. pylori infection and to seroconversion. The level of education was strongly related to the prevalence, but not to the incidence of H. pylori infection. The presence of infection over the time was associated with a higher percentage of heartburn, regurgitation, and nausea compared with subjects who were continuously negative for H. pylori infection.