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Changing Patterns of Mycobacterial Disease at a Teaching Community Hospital

Published online by Cambridge University Press:  02 January 2015

Jeffrey N. Cox ,
Eric R. Brenner  and
Charles S. Bryan
Jeffrey N. Cox
Affiliation:
Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina
Eric R. Brenner
Affiliation:
Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina
Charles S. Bryan*
Affiliation:
Department of Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina
*
2 Richland Medical Park, Suite 502, Columbia, SC 29203
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Abstract

Objectives:

To evaluate trends in the occurrence and diagnosis of mycobacterial disease.

Design:

Prospective surveillance study using a central tuberculosis registry at a 611-bed teaching community hospital.

Results:

Data pertaining to 715 patients were entered into the registry between 1976 and 1991 on the basis of positive smears or cultures for acid-fast bacilli (AFB). Over time, the ratio of isolates of Mycobacterium tuberculosis to isolates of nontuberculous mycobacteria reversed (from 3.2 to 1 between 1976 and 1981 to 1 to 1.6 between 1986 and 1991). The sensitivity of the sputum AFB smear for diagnosis of pulmonary tuberculosis increased (from 0.73 to 0.96), but the positive predictive value of the sputum AFB smear declined (from 0.72 to 0.59). The acquired immunodeficiency syndrome epidemic accounted for these changes only to a small extent.

Conclusions:

The increasing occurrence of non-tuberculous mycobacterial disease and the declining positive predictive value of the sputum AFB smear at this hospital imply that respiratory isolation and antituberculous therapy will be used inappropriately for many patients. The development and use of newer tests for early isolation and specific identification of M tuberculosis should be accelerated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 8 , August 1994 , pp. 513 - 515
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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