Service des Maladies Infectieuses et Tropicales, CHU Bichat-Claude-Bernard, 75018 Paris, France.
Med Mal Infect. 2012 Mar;42(3):110-3. doi: 10.1016/j.medmal.2011.12.003. Epub 2012 Mar 6.
The treatment of community-acquired pneumonia relies on empirical antibacterial treatment, guided by chest X-ray. We evaluated the impact of this practice on delay in the diagnosis of pulmonary tuberculosis.
We performed a retrospective monocentric study on 64 documented cases of pulmonary tuberculosis.
Empirical antibacterial treatment was prescribed between the first symptoms and pulmonary tuberculosis diagnosis in 42.2% of cases. The median delay between first contact with a healthcare provider and pulmonary tuberculosis treatment initiation (medical delay) was 13.5 days. The factors associated with medical delay above 30 days were alcohol abuse (OR 7.62; P = 0.02), and late chest X-ray (OR 9.33; P = 0.01). Empirical antibacterial treatment was more frequent in case of late chest X-ray (P = 0.02) and increased the risk of medical delay above 7 days (OR 6.3; P = 0.05).
When lower respiratory tract infection is suspected, early chest X-ray reduces the empirical use of antibacterial agents and decreases delay in the diagnosis of pulmonary tuberculosis.
社区获得性肺炎的治疗依赖于经验性抗菌治疗，以胸部 X 光为指导。我们评估了这种做法对肺结核诊断延迟的影响。
我们对 64 例确诊的肺结核病例进行了回顾性单中心研究。
在 42.2%的病例中，在出现第一个症状和肺结核诊断之间开具了经验性抗菌治疗。从首次接触医疗保健提供者到开始肺结核治疗（医疗延误）的中位数为 13.5 天。与超过 30 天的医疗延误相关的因素包括酗酒（OR 7.62；P = 0.02）和胸部 X 线片较晚（OR 9.33；P = 0.01）。在胸部 X 线片较晚的情况下，经验性抗菌治疗更为常见（P = 0.02），并且增加了超过 7 天的医疗延误的风险（OR 6.3；P = 0.05）。
当怀疑下呼吸道感染时，早期胸部 X 光可减少抗菌药物的经验性使用，并减少肺结核的诊断延迟。
