Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2019 Nov 11;34(43):e270. doi: 10.3346/jkms.2019.34.e270.
Delays in isolating patients admitted to hospital with active pulmonary tuberculosis (PTB) can contribute to nosocomial transmission; however, in Korea, patients with clinically diagnosed PTB are not routinely isolated while awaiting microbiological confirmation of the diagnosis. We aimed to assess the extent of delays in isolating patients admitted with PTB and to identify the factors associated with delayed isolation.
We retrospectively reviewed the electronic medical records of patients aged ≥ 18 years with active PTB, between January 2008 and December 2017, from two Korean hospitals.
Among 1,062 patients, 612 (57.6%) were not isolated on admission day. The median time from admission to isolation was 1 day (interquartile range: 0-2 days). The independent risk factor most strongly associated with delayed isolation was admission to departments other than pulmonology or infectious diseases departments (adjusted odds ratio [aOR], 5.302; 95% confidence interval [CI], 3.177-8.847; < 0.001). Factors associated with isolation on admission day were a past history of tuberculosis (TB) (aOR, 0.669; 95% CI, 0.494-0.906; = 0.009), night sweats (aOR, 0.530; 95% CI, 0.330-0.851; = 0.009), and apical infiltrates on chest radiographs (aOR, 0.452; 95% CI, 0.276-0.740; = 0.002).
Concerning patients subsequently diagnosed with active PTB, > 50% were not isolated on admission day. We suggest that the patients with clinically suspected PTB including the elderly who have a past history of TB, night sweats, or apical infiltration on chest radiographs, be presumptively isolated on admission, without waiting for microbiological confirmation of the diagnosis.
患有活动期肺结核（PTB）的住院患者若延迟隔离，可能会导致医院内传播；然而，在韩国，临床诊断为 PTB 的患者在等待微生物学确诊期间并未常规进行隔离。本研究旨在评估延迟隔离确诊为 PTB 的患者的程度，并确定与延迟隔离相关的因素。
我们回顾性分析了 2008 年 1 月至 2017 年 12 月期间来自韩国两家医院的年龄≥18 岁、患有活动期 PTB 的患者的电子病历。
在 1062 名患者中，有 612 名（57.6%）在入院当天未进行隔离。从入院到隔离的中位时间为 1 天（四分位间距：0-2 天）。与延迟隔离最密切相关的独立危险因素是收入肺病科或传染病科以外的科室（校正优势比[aOR]，5.302；95%置信区间[CI]，3.177-8.847；<0.001）。入院当天进行隔离的相关因素包括肺结核（TB）既往史（aOR，0.669；95%CI，0.494-0.906；=0.009）、夜间盗汗（aOR，0.530；95%CI，0.330-0.851；=0.009）和胸部 X 线片上的尖部浸润（aOR，0.452；95%CI，0.276-0.740；=0.002）。
对于随后诊断为活动期 PTB 的患者，超过 50%的患者在入院当天未进行隔离。我们建议对包括老年人在内的具有肺结核既往史、夜间盗汗或胸部 X 线片上尖部浸润等临床疑似 PTB 的患者进行入院时的推测性隔离，而无需等待诊断的微生物学确认。
