Brigham and Women's Hospital, Boston, Massachusetts, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Infect Control Hosp Epidemiol. 2022 Oct;43(10):1459-1465. doi: 10.1017/ice.2021.422. Epub 2021 Oct 6.
To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.
Prospective cohort study with historical controls.
Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.
The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.
We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39-3.21; < .001).
Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.
评估在结核病流行地区的一家综合医院中，使用快速行动（主动发现病例、安全隔离、有效治疗）策略对结核病诊断和治疗时间的影响。
前瞻性队列研究，设历史对照。
在秘鲁利马 Hipolito Unanue 国立医院住院期间被诊断为肺结核的患者。
2016 年 7 月 24 日至 2019 年 12 月 31 日实施 FAST 策略。我们比较了在 FAST 前后 6 个月内接受药物敏感性试验和结核病治疗的患者比例。使用 Kaplan-Meier 图和 Cox 回归比较诊断和结核病治疗的时间。
我们分析了通过 FAST 诊断为肺结核的 75 例患者。历史队列包括 76 例患者。更多的 FAST 患者接受了药物敏感性试验（98.7%对 57.8%；OR，53.8；<.001），这导致前瞻性队列中 74 例中的 18 例（24.3%）和历史队列中 44 例中的 4 例（9%）被诊断为耐多药结核病（OR，3.2；=0.03）。总体而言，55 例（73.3%）FAST 患者在住院期间开始结核病治疗，而 39 例（51.3%）对照患者开始治疗（OR，2.44；=0.012）。FAST 缩短了从入院到开始结核病治疗的时间（HR，2.11；95%CI，1.39-3.21；<.001）。
在结核病流行地区的综合医院中，使用 FAST 策略可改善耐多药结核病的诊断，并提高肺结核患者开始治疗的可能性和速度。在这些环境中，应考虑使用 FAST 策略来减少结核病传播，同时提高护理质量。
