J Korean Med Sci.  2019 Nov;34(43):e270. 10.3346/jkms.2019.34.e270.

Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea

• Heo DH
• Seo JW
• Kim JH
• Chun JY
• Jun KI
• Kang CK
• Moon SM
• Song KH
• Choe PG
• Park WB
• Bang JH
• Kim ES
• Park SW
• Kim NJ
• Oh MD
• Kim HB

• KMID: 2461870
• DOI: http://doi.org/10.3346/jkms.2019.34.e270

Abstract

BACKGROUND
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.
METHODS
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.
RESULTS
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; P < 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; P = 0.009), night sweats (aOR, 0.530; 95% CI, 0.330-0.851; P = 0.009), and apical infiltrates on chest radiographs (aOR, 0.452; 95% CI, 0.276-0.740; P = 0.002).
CONCLUSION
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.

Keyword

Pulmonary Tuberculosis; Isolation; Transmission

MeSH Terms

Aged
Communicable Diseases
Diagnosis
Electronic Health Records
Humans
Korea*
Odds Ratio
Pulmonary Medicine
Radiography, Thoracic
Retrospective Studies
Risk Factors
Sweat
Tuberculosis
Tuberculosis, Pulmonary*