This study was presented at the 20th ECCMID, Vienna, Austria (10–13 April 2010), abstract 2717.
Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study
Article first published online: 3 MAY 2010
© 2010 The Authors. Journal Compilation © 2010 European Society of Clinical Microbiology and Infectious Diseases
Clinical Microbiology and Infection
Volume 17, Issue 4, pages 610–614, April 2011
How to Cite
Lagrange-Xélot, M., Porcher, R., Gallien, S., Wargnier, A., Pavie, J., de Castro, N. and Molina, J.-M. (2011), Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study. Clinical Microbiology and Infection, 17: 610–614. doi: 10.1111/j.1469-0691.2010.03259.x
- Issue published online: 3 MAY 2010
- Article first published online: 3 MAY 2010
- Original Submission: 1 December 2009; Revised Submission: 17 April 2010; Accepted: 20 April 2010 Editor: M. Paul Article published online: 3 May 2010
- Clinical decision rule;
- pulmonary tuberculosis;
- respiratory isolation
Clin Microbiol Infect 2011; 17: 610–614
Guidelines help to prevent the transmission of Mycobacterium tuberculosis in healthcare settings, but may also result in the unnecessary isolation of many patients. We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a pre-existing clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. In conclusion, the prevalence of PTB among isolated inpatients was high, and the use of a clinical decision rule in addition to clinical impression might improve isolation decisions.