Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia

作者：Zhang Z X^*; Sng L H; Yong Y; Lin L M; Cheng T W; Seong N H; Yong F K

来源：International Journal of Tuberculosis and Lung Disease, 2017, 21(5): 544-549.

DOI：10.5588/ijtld.16.0667

• pulmonary tuberculosis
• severity
• AFB smear
• transmission

BACKGROUND: Diagnostic and treatment delays increase the severity and transmission of pulmonary tuberculosis (PTB). This study aimed to evaluate TB diagnostic and treatment delays in acid-fast bacilli (AFB) smear-negative patients.
METHODS: This was a retrospective observational study. Patients with positive AFB culture of Mycobacterium tuberculosis complex (MTC) were selected from among hospitalised patients with a diagnosis of pneumonia. Admission ward, anti-tuberculosis treatment and the duration of AFB culture were compared between smear-positive and smear-negative patients.
RESULTS: Of the 70 patients with positive isolation of MTC in AFB culture, 27 (38.5%) were smear-negative; of these, 18 (66.7%) were not isolated while in hospital, and 17 (63%) were neither diagnosed nor treated for TB. In contrast, 41 of the 43 smear-positive patients (95.3%) were directly admitted or quickly transferred to the isolation room and started on anti-tuberculosis treatment (P < 0.001). Samples from smear-negative patients required more time to grow MTC in AFB culture than those of smear-positive patients (23 days vs. 14 days, P < 0.001). Diabetes was significantly associated with AFB smear positivity, with an odds ratio of 12.2.
CONCLUSIONS: Negative AFB smears caused significant diagnostic and treatment delay. Patients staying in the general ward were exposed to TB patients who were not diagnosed in time.

• 出版日期2017-5