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

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, 1990, to August 31, 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.