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How Soon Should Patients with Smear-Positive Tuberculosis Be Released from Inpatient Isolation?

Published online by Cambridge University Press:  02 January 2015

David J. Horne ,
Catherine O. Johnson ,
Eyal Oren ,
Christopher Spitters  and
Masahiro Narita
David J. Horne*
Affiliation:
Divisions of Pulmonary and Critical Care Medicine, Seattle, Washington
Catherine O. Johnson
Affiliation:
Department of Medicine, University of Washington School of Medicine; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
Eyal Oren
Affiliation:
Public Health-Seattle & King County, Tuberculosis Control Program, Seattle, Washington
Christopher Spitters
Affiliation:
Allergy and Infectious Diseases, Seattle, Washington Public Health-Seattle & King County, Tuberculosis Control Program, Seattle, Washington
Masahiro Narita
Affiliation:
Divisions of Pulmonary and Critical Care Medicine, Seattle, Washington Department of Medicine, University of Washington School of Medicine; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington Public Health-Seattle & King County, Tuberculosis Control Program, Seattle, Washington
*
Harborview Medical Center, 325 9th Avenue, Box 359762, Seattle, WA 98104 ([email protected])
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Extract

Objective.

In patients with smear-positive pulmonary tuberculosis who are hospitalized or reside in congregate settings, guidelines recommend airborne infection isolation until sputum smear results are negative. Studies have identified factors associated with delayed sputum smear and culture conversion in patients with tuberculosis. Because these studies did not use methods of survival analysis, estimates of time to sputum smear conversion that are based on initial patient characteristics are not available. The ability to predict time to sputum smear conversion could be useful for programmatic planning and patient counseling.

Methods.

We performed a cohort study using survival analysis to identify factors associated with time to sputum smear and culture conversion. We defined the time to sputum smear conversion as the time elapsed from the start of treatment to the first date of sustained conversion.

Results.

Ninety-eight patients had sputum smear samples positive for acid-fast bacilli. Lower initial smear grade (on 1+ to 4+ scale) and absence of cavitation on chest radiograph were associated with earlier sputum smear conversion in bivariate analysis. In multiple regression analysis, initial smear grade (hazard ratio, 0.45; 95% confidence interval, 0.35-0.57) and drug resistance (hazard ratio, 2.30; 95% confidence interval, 1.08-4.89) remained statistically significant; a model comprising only initial smear grade performed almost as well. Predictors of sputum culture conversion were similar.

Conclusions.

Initial smear grade was the strongest predictor of time to sputum smear and culture conversion in patients with pulmonary tuberculosis and may be a useful predictor for programmatic planning and patient counseling.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 78 - 84
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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