Department of Internal Medicine, Ewha Womans University, Mokdong Hospital, Seoul, South Korea.
Department of Radiology, Ewha Womans University, Mokdong Hospital, Seoul, South Korea.
Clin Microbiol Infect. 2020 Aug;26(8):1058-1062. doi: 10.1016/j.cmi.2020.01.032. Epub 2020 Feb 6.
The aim was to examine the rate of delayed or no isolation of hospitalized patients with pulmonary tuberculosis (TB) and the causes for isolation failure.
This retrospective study included patients with pulmonary TB at a university-affiliated hospital in South Korea between January 2015 and June 2018 after excluding those with a stay ≤2 days and those who only visited the emergency department. Patients who were not isolated for ≥3 days were classified as the delayed or no isolation group. We compared the clinical findings and diagnostic test results, between patients managed with delayed or no isolation (D-isolation) and timely isolation (T-isolation).
Of 486 patients with pulmonary TB, 222 patients were included. In 106 cases (47.7%), isolation was delayed or not applied, while in 116 cases, isolation was applied in a timely manner. Typical findings of TB were seen on the chest X-rays of 87 (75.0%) patients in the T-isolation group versus 25 (23.6%) patients in the D-isolation group (p < 0.001). Other factors significantly associated with delayed or no isolation on univariate analyses were older age, admission route (emergency room vs. other), admitting department, negative acid-fast bacilli (AFB) stain, and negative MTB PCR. On multivariate analysis, admission through an outpatient clinic, admission to a department other than infectious diseases or pulmonology, an atypical chest X-ray finding and negative sputum AFB stains were risk factors for isolation failure.
Delayed or no isolation of patients with pulmonary TB was attributed mainly to atypical radiological findings and negative findings of direct TB diagnostic tests.
本研究旨在调查医院中肺结核（TB）患者隔离延迟或未隔离的发生率，并分析隔离失败的原因。
本回顾性研究纳入了 2015 年 1 月至 2018 年 6 月期间在韩国一家大学附属医院住院的肺结核患者，排除住院时间≤2 天和仅就诊于急诊科的患者。未隔离≥3 天的患者被归类为隔离延迟或未隔离组。我们比较了延迟或未隔离（D-隔离）与及时隔离（T-隔离）患者的临床发现和诊断检测结果。
在 486 例肺结核患者中，纳入了 222 例患者。在 106 例（47.7%）患者中，隔离延迟或未实施，而在 116 例患者中，及时实施了隔离。在 T-隔离组中，87 例（75.0%）患者的 X 线胸片有典型的 TB 表现，而在 D-隔离组中，25 例（23.6%）患者有典型的 TB 表现（p<0.001）。单因素分析显示，年龄较大、就诊途径（急诊 vs. 其他）、收治科室、抗酸杆菌（AFB）染色阴性和 MTB PCR 阴性与隔离延迟或未隔离显著相关。多因素分析显示，门诊就诊、收入感染科或肺病科以外的科室、胸片表现不典型和痰 AFB 染色阴性是隔离失败的危险因素。
肺结核患者隔离延迟或未隔离主要归因于不典型的影像学表现和直接 TB 诊断检测的阴性结果。
