Chitnis Amit S, Davis J Lucian, Schecter Gisela F, Barry Pennan M, Flood Jennifer M
1Tuberculosis Control Branch,Division of Communicable Disease Control,Center for Infectious Diseases,California Department of Public Health,Richmond,California.
2Department of Epidemiology of Microbial Diseases,School of Public Health,and Division of Pulmonary, Critical Care,& Sleep Medicine,School of Medicine,Yale University,New Haven,Connecticut.
Infect Control Hosp Epidemiol. 2015 Oct;36(10):1215-25. doi: 10.1017/ice.2015.145. Epub 2015 Jul 13.
Tuberculosis (TB) remains an important cause of hospitalization and mortality in the United States. Prevention of TB transmission in acute care facilities relies on prompt identification and implementation of airborne isolation, rapid diagnosis, and treatment of presumptive pulmonary TB patients. In areas with low TB burden, this strategy may result in inefficient utilization of airborne infection isolation rooms (AIIRs). We reviewed TB epidemiology and diagnostic approaches to inform optimal TB detection in low-burden settings. Published clinical prediction rules for individual studies have a sensitivity ranging from 81% to 100% and specificity ranging from 14% to 63% for detection of culture-positive pulmonary TB patients admitted to acute care facilities. Nucleic acid amplification tests (NAATs) have a specificity of >98%, and the sensitivity of NAATs varies by acid-fast bacilli sputum smear status (positive smear, ≥95%; negative smear, 50%-70%). We propose an infection prevention strategy using a clinical prediction rule to identify patients who warrant diagnostic evaluation for TB in an AIIR with an NAAT. Future studies are needed to evaluate whether use of clinical prediction rules and NAATs results in optimized utilization of AIIRs and improved detection and treatment of presumptive pulmonary TB patients.
在美国，结核病（TB）仍然是住院和死亡的重要原因。在急性护理机构中预防结核病传播依赖于及时识别并实施空气传播隔离、快速诊断以及对疑似肺结核患者进行治疗。在结核病负担较低的地区，这种策略可能导致空气传播感染隔离病房（AIIRs）利用效率低下。我们回顾了结核病流行病学和诊断方法，以指导在低负担环境中进行最佳结核病检测。针对个体研究发表的临床预测规则，对于检测入住急性护理机构的痰培养阳性肺结核患者，其灵敏度范围为81%至100%，特异度范围为14%至63%。核酸扩增检测（NAATs）的特异度>98%，其灵敏度因抗酸杆菌痰涂片状态而异（涂片阳性，≥95%；涂片阴性，50%-70%）。我们提出一种感染预防策略，即使用临床预测规则来识别那些需要在AIIR中通过NAAT进行结核病诊断评估的患者。未来需要开展研究，以评估使用临床预测规则和NAATs是否能优化AIIRs的利用，并改善对疑似肺结核患者的检测和治疗。
