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Use of airborne infection isolation in potential cases of pulmonary tuberculosis

Published online by Cambridge University Press:  16 March 2020

James H. England Open the ORCID record for James H. England [Opens in a new window] ,
Daniel W. Byrne ,
Bryan D. Harris  and
Thomas R. Talbot
James H. England
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Daniel W. Byrne
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
Bryan D. Harris
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Thomas R. Talbot*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Thomas R. Talbot, E-mail: [email protected]
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Abstract

Objective:

To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.

Methods:

Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.

Results:

Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.

Conclusions:

The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 505 - 509
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

†

Present affiliation: The Christ Hospital, Cincinnati, Ohio

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