Department of Radiology, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea.
Department of Internal Medicine, Division of Infectious Diseases, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2020 Aug;215(2):359-366. doi: 10.2214/AJR.19.22540. Epub 2020 May 20.
The purpose of this study was to determine factors related to delayed isolation of patients hospitalized with active pulmonary tuberculosis (TB). A total of 130 immunocompetent hospitalized patients with active pulmonary TB who had positive sputum culture results from January 2015 to December 2017 were reviewed. Delayed isolation of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of hospitalization. Clinical and microbiologic characteristics of the patients and radiologic features on chest radiography ( = 130) and chest CT ( = 118) were retrospectively reviewed. Findings were compared between patients with early isolation and those with delayed isolation. Univariate and multivariate analyses were performed to determine independent predictors of delayed isolation. Forty-four patients (34%) had delayed isolation after initial hospitalization. On univariate and multivariate analyses, atypical presentation of active pulmonary TB on CT (odds ratio, 7.203; 95% CI, 2.203-23.551; = 0.001) and concurrent lung parenchymal diseases on CT (odds ratio, 14.605; 95% CI, 3.274-65.155; < 0.001) were significant predictors of delayed isolation of patients with active pulmonary TB. Awareness of the factors related to delayed diagnosis of active pulmonary TB is important to avoid an unexpected in-hospital outbreak of TB and control the disease. Atypical presentation of active pulmonary TB and concurrent lung parenchymal diseases on CT are significant factors related to delayed isolation of hospitalized patients with active pulmonary TB.
本研究旨在确定与住院活动性肺结核（TB）患者隔离延迟相关的因素。回顾性分析了 2015 年 1 月至 2017 年 12 月期间 130 例免疫功能正常的住院活动性肺结核患者，这些患者的痰培养结果均为阳性。将肺结核延迟隔离定义为在住院的前 3 天内未开始进行空气传播隔离。回顾性分析了患者的临床和微生物学特征以及胸部 X 线（n = 130）和胸部 CT（n = 118）的放射学特征。比较了早期隔离患者和延迟隔离患者的结果。进行了单因素和多因素分析，以确定延迟隔离的独立预测因素。44 例患者（34%）在初次住院后出现延迟隔离。在单因素和多因素分析中，CT 上活动性肺结核的非典型表现（优势比，7.203；95%CI，2.203-23.551； = 0.001）和 CT 上同时存在肺实质疾病（优势比，14.605；95%CI，3.274-65.155； < 0.001）是活动性肺结核患者隔离延迟的显著预测因素。了解与活动性肺结核延迟诊断相关的因素对于避免医院内结核病意外暴发和控制疾病非常重要。CT 上活动性肺结核的非典型表现和同时存在的肺实质疾病是与住院活动性肺结核患者隔离延迟相关的重要因素。
