Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study
Guidelines help to prevent the transmission of Mycobacterium tuberculosis in healthcare settings, but may also result in the unnecessary isolation of many patients. We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatie...
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| Veröffentlicht in: | Clinical microbiology and infection 2011-04, Vol.17 (4), p.610-614 |
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| creator | Lagrange-Xélot, M. Porcher, R. Gallien, S. Wargnier, A. Pavie, J. de Castro, N. Molina, J.-M. |
| description | Guidelines help to prevent the transmission of Mycobacterium tuberculosis in healthcare settings, but may also result in the unnecessary isolation of many patients. We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a preexisting clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p |
| doi_str_mv | 10.1111/j.1469-0691.2010.03259.x |
| format | Article |
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We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a preexisting clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. In conclusion, the prevalence of PTB among isolated inpatients was high, and the use of a clinical decision rule in addition to clinical impression might improve isolation decisions.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1111/j.1469-0691.2010.03259.x</identifier><identifier>PMID: 20459437</identifier><language>eng</language><publisher>Oxford, UK: Elsevier Ltd</publisher><subject>Adult ; Animals ; Bacterial diseases ; Bacterial diseases of the respiratory system ; Biological and medical sciences ; Chest ; Clinical decision rule ; Decision Support Systems, Clinical ; Disease transmission ; Female ; Fever ; Hospitals ; Human bacterial diseases ; Human immunodeficiency virus ; Humans ; Infection ; Infectious diseases ; Ionizing radiation ; Lung ; Male ; Medical sciences ; Middle Aged ; Mycobacterium tuberculosis ; Mycobacterium tuberculosis - isolation & purification ; Predictive Value of Tests ; Prevalence ; Prospective Studies ; pulmonary tuberculosis ; respiratory isolation ; Sweat ; Tuberculosis ; Tuberculosis and atypical mycobacterial infections ; Tuberculosis, Pulmonary - diagnosis ; Tuberculosis, Pulmonary - epidemiology ; Tuberculosis, Pulmonary - pathology</subject><ispartof>Clinical microbiology and infection, 2011-04, Vol.17 (4), p.610-614</ispartof><rights>2011 European Society of Clinical Infectious Diseases</rights><rights>2010 The Authors. Journal Compilation © 2010 European Society of Clinical Microbiology and Infectious Diseases</rights><rights>2015 INIST-CNRS</rights><rights>2010 The Authors. 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We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a preexisting clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. 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We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a preexisting clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. In conclusion, the prevalence of PTB among isolated inpatients was high, and the use of a clinical decision rule in addition to clinical impression might improve isolation decisions.</abstract><cop>Oxford, UK</cop><pub>Elsevier Ltd</pub><pmid>20459437</pmid><doi>10.1111/j.1469-0691.2010.03259.x</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Animals Bacterial diseases Bacterial diseases of the respiratory system Biological and medical sciences Chest Clinical decision rule Decision Support Systems, Clinical Disease transmission Female Fever Hospitals Human bacterial diseases Human immunodeficiency virus Humans Infection Infectious diseases Ionizing radiation Lung Male Medical sciences Middle Aged Mycobacterium tuberculosis Mycobacterium tuberculosis - isolation & purification Predictive Value of Tests Prevalence Prospective Studies pulmonary tuberculosis respiratory isolation Sweat Tuberculosis Tuberculosis and atypical mycobacterial infections Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - pathology |
| title | Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study |
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