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

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.

Estimating the burden of nosocomial exposure to tuberculosis in South Korea, a nationwide population based cross-sectional study

“…In several studies recently published in South Korea, hospitalization to a department other than a pulmonology or infectious diseases department, suggesting non-respiratory related hospitalization was a significant risk factor delayed isolation of hospitalized TB patients [46][47][48]. In those studies, more comorbidities such as malignancy, cardiovascular disease, chronic kidney disease were identified among the delayed isolation groups.…”

Characteristics and risk factors associated with missed diagnosis in patients with smear-negative pulmonary tuberculosis

“…In this study, we found that the diagnosis of more than half of all patients with smear-negative pulmonary TB (53.2%) was delayed until the confirmation of positive culture results. Such a delay could contribute to disease transmission within the hospital [10] and community.…”

Latent tuberculosis infection screening and treatment in congregate settings (TB FREE COREA): protocol for a prospective observational study in Korea

“…Because of high incidence of nosocomial TB infection among healthcare workers23 and delay in isolating active pulmonary TB patients admitted to hospitals24 in South Korea, the Korean TB guideline highlights the importance of serial IGRA testing for high-risk healthcare workers and recommend treating those with positive conversion. However, recent studies suggest that serial IGRA testing results in an over-diagnosis of LTBI25 and are not cost-effective26 in the North American setting.…”