Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients. A prospective study.
Clin Microbiol Infect. 2010 May 3;
Authors: Lagrange-XÃ©lot M, Porcher R, Gallien S, Wargnier A, Pavie J, de Castro N, Molina JM
Abstract Guidelines help to prevent the transmission of Mycobacterium tuberculosis in health-care settings but may also result in 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). We also wished to validate a pre-existing 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 based on clinical and radiological findings without 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 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 use of a clinical decision rule in addition to clinical impression might improve isolation decisions.
PMID: 20459437 [PubMed - as supplied by publisher]