Characteristics and risk factors associated with missed diagnosis in patients with smear-negative pulmonary tuberculosis
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Background/Aims: Delayed diagnosis and treatment of smear-negative pulmonary tuberculosis (TB) are major concerns for TB control. We evaluated characteristics of patients with smear-negative pulmonary TB who received a delayed diagnosis and identified risk factors that may have contributed to this delay. Methods: We reviewed medical records of patients with smear-negative culturepositive pulmonary TB treated at a tertiary care hospital in South Korea between January 2017 and December 2018. Patients who initiated anti-TB treatment after positive cultures were included in the missed TB group, and those who initiated empirical treatment before positive cultures were included in the control group. Results: Of 220 patients included, 117 (53.2%) and 103 (46.8%) were in the missed TB and control groups, respectively. Patients in the missed TB group were older (p = 0.001) and had a higher mean body mass index (BMI) (p = 0.019). Comorbidities (66.9% vs. 46.6%, p = 0.003) and immunocompromised patients (33.1% vs. 20.4%, p = 0.035) were more common in the missed TB group than in the control group. Old age (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.012 to 1.048; p = 0.001), high BMI (OR, 1.114; 95% CI, 1.004 to 1.237; p = 0.042), and negative polymerase chain reaction (PCR) results (OR, 9.551; 95% CI, 4.925 to 18.521; p < 0.001) were associated with delayed diagnosis. Conclusions: In more than half of patients with smear-negative pulmonary TB, the diagnosis was delayed. Patients with delayed TB diagnosis were older, had higher BMI, and negative PCR results.
Abstract
Background/Aims: Delayed diagnosis and treatment of smear-negative pulmonary tuberculosis (TB) are major concerns for TB control. We evaluated characteristics of patients with smear-negative pulmonary TB who received a delayed diagnosis and identified risk factors that may have contributed to this delay. Methods: We reviewed medical records of patients with smear-negative culturepositive pulmonary TB treated at a tertiary care hospital in South Korea between January 2017 and December 2018. Patients who initiated anti-TB treatment after positive cultures were included in the missed TB group, and those who initiated empirical treatment before positive cultures were included in the control group. Results: Of 220 patients included, 117 (53.2%) and 103 (46.8%) were in the missed TB and control groups, respectively. Patients in the missed TB group were older (p = 0.001) and had a higher mean body mass index (BMI) (p = 0.019). Comorbidities (66.9% vs. 46.6%, p = 0.003) and immunocompromised patients (33.1% vs. 20.4%, p = 0.035) were more common in the missed TB group than in the control group. Old age (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.012 to 1.048; p = 0.001), high BMI (OR, 1.114; 95% CI, 1.004 to 1.237; p = 0.042), and negative polymerase chain reaction (PCR) results (OR, 9.551; 95% CI, 4.925 to 18.521; p < 0.001) were associated with delayed diagnosis. Conclusions: In more than half of patients with smear-negative pulmonary TB, the diagnosis was delayed. Patients with delayed TB diagnosis were older, had higher BMI, and negative PCR results.
참고문헌 (20)
- World Health Organization, "WHO Guidelines on Tuberculosis Infection Prevention and Control, 2019 Update", World Health Organization, ~ (2019)
- Churchyard G, "What we know about tuberculosis transmission : an overview", J Infect Dis, 216, pp.S629~S635 (2017)
- Rossato Silva D, "Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting : a cross-sectional study", BMC Infect Dis, 12, pp.57~ (2012)
- Piatek AS, "GeneXpert for TB diagnosis : planned and purposeful implementation", Glob Health Sci Pract, 1, pp.18~23 (2013)
- Aber VR, "Quality control in tuberculosis bacteriology. 1. Laboratory studies on isolated positive cultures and the efficiency of direct smear examination", Tubercle, 61, pp.123~133 (1980)
- Korea Centers for Disease Control and Prevention, "Manual of Laboratory Tests for Tuberculosis" (2013), Korea Centers for Disease Control and Prevention
- World Health Organization, "Guidelines for Treatment of Tuberculosis" (2010), World Health Organization
- Korea Academy of Tuberculosis and Respiratory Diseases, "Korean Guidelines for Tuberculosis" (2017), Korea Centers for Disease Control and Prevention
- Definitions and Reporting Framework for Tuberculosis: 2013 Revision, "World Health Organization", World Health Organization, ~ (2013)
- 허대혁, "Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea", Journal of Korean Medical Science, 34(43), pp.1~8 (2019), 대한의학회
- Storla DG, "A systematic review of delay in the diagnosis and treatment of tuberculosis", BMC Public Health, 8, pp.15~ (2008)
- Lee CH, "Treatment delay and fatal outcomes of pulmonary tuberculosis in advanced age : a retrospective nationwide cohort study", BMC Infect Dis, 17, pp.449~ (2017)
- Yoshikawa TT, "Tuberculosis in aging adults", J Am Geriatr Soc, 40, pp.178~187 (1992)
- 이승헌, "Active Case Finding in the Elderly Tuberculosis in South Korea", Tuberculosis and Respiratory Diseases, 82(3), pp.261~263 (2019), 대한결핵및호흡기학회
- Cantalice Filho JP, "Analysis of the treatment of pulmonary tuberculosis in elderly patients at a university hospital in Rio De Janeiro, Brazil", J Bras Pneumol, 33, pp.691~698 (2007)
- Shu CC, "Hepatotoxicity due to first-line anti-tuberculosis drugs : a fiveyear experience in a Taiwan medical centre", Int J Tuberc Lung Dis, 17, pp.934~939 (2013)
- Leung CC, "Tuberculosis in older people : a retrospective and comparative study from Hong Kong", J Am Geriatr Soc, 50, pp.1219~1226 (2002)
- Han J, "Risk factors for delayed isolation of patients with active pulmonary tuberculosis in an acute-care hospital", Sci Rep, 9, pp.4849~ (2019)
- Lombardi G, "Diagnosis of smear-negative tuberculosis is greatly improved by Xpert MTB", RIF, 2017, pp.12, e0176186~
- Dorman SE, "Xpert MTB", RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance : a prospective multicentre diagnostic accuracy study, 2018, pp.18, 76~84