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Kang, Lee, Chung, Han, Byun, Chung, Park, Kim, Kim, Chang, and Kim: Delayed Treatment of Pulmonary Tuberculosis in a University Hospital
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(3): 277-284.

Published online: 31 March 2006

DOI: https://doi.org/10.4046/trd.2006.60.3.277

Delayed Treatment of Pulmonary Tuberculosis in a University Hospital

Shin Myung Kang, M.D.1, Jun Gu Lee, M.D.1, Jae Ho Chung, M.D.4, Chang Hoon Han, M.D.1, Min Kwang Byun, M.D.1, Wou Youn Chung, M.D.1, Moo Suk Park, M.D.1, Young Sam Kim, M.D.1, 2, Se Kyu Kim, M.D.1, 2, 3, Joon Chang, M.D.1, 2, Sung Kyu Kim, M.D.1, 2

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.

3Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea.

4Department of Internal Medicine, Kwandong University College of Medicine, Myongji hospital, Goyang, Korea.

Address for correspondence: Sung Kyu Kim, M.D. Department of Internal Medicine, Yonsei University, College of Medicine, COP Box 8044, Seoul, Korea. Phone: 82-2-2228-1938, Fax: 82-2-393-6884, skkimpul@yumc.yonsei.ac.kr

Received 4 January 2006       Accepted 15 February 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Delayed treatment of pulmonary tuberculosis is an important problem because it results in greater mortality and the nosocomial transmission of tuberculosis. This study was conducted to analyze the factors that contribute to the delayed treatment of pulmonary tuberculosis in a university hospital and we wanted to provide basic data for instituting an effective management program for tuberculosis.

Methods

we retrospectively reviewed the medical records of 155 patients with smear-positive or culture-positive pulmonary tuberculosis and who were treated between May 1999 and October 1999. A case-control study was performed to analyze the factors. We then tried to follow up the patients in delayed treatment group via telephone for the purpose of assessing the therapeutic interventions.

Results

Among 150 patients, 55 (37%) were included in the delayed treatment group. The factors associated with delayed treatment on the univariate analysis included age (61 vs 40 years old; p <0.001), a smear-negative sputum test for acid-fast bacilli (AFB) (85% vs 55%; p <0.001) and no visits to a private clinic before the patient presented to the university hospital (56% vs 36%; p = 0.014). Multivariate analysis revealed that old age (p = 0.001), a smear-negative sputum for AFB (p = 0.001), and lower lobe infiltrate on chest X-ray (p = 0.041) were the independent predictors of delayed treatment. Of the 22 patients who did not receive any treatment, 20 of them 91%) consented to our suggestion of revisiting the hospital.

Conclusion

Delayed treatment of patients with pulmonary tuberculosis is not uncommon in a university hospital. Old age, smear-negative for AFB, and lower lobe infiltrate on chest X-ray are the risk factors for delayed treatment. A more systematic management system is required for achieving better control of tuberculosis.

Keywords: Tuberculosis, Delayed treatment

Figures and Tables

Figure 1
Results of telephone follow-up of patients in delayed treatment group.
trd-60-277-g001
Table 1
Baseline characteristics of the patients
trd-60-277-i001

*standard deviation

†interquartile range

Results expressed as numbers (%), mean ± SD, and median (IQR)

Table 2
Results of acid-fast stain and mycobacterial culture of the patients
trd-60-277-i002
Table 3
Univariate analysis of features associated with delayed treatment
trd-60-277-i003

*interquartile range

Results expressed as numbers (%) and median (IQR)

Table 4
Multivariate analysis of features associated with delayed treatment
trd-60-277-i004

*confidence interval

References

2. National Statistics Office. Annual report of death statistics data in 2001. 2002. Korea:
3. Liam CK, Tang BG. Delay in the diagnosis and treatment of pulmonary tuberculosis in patients attending a university teaching hospital. Int J Tuberc Lung Dis. 1997. 1:326–332.
4. Venkatarama KR, Iademarco EP, Fraser VJ, Kollef MH. Delays in the suspicion and treatment of tuberculosis among hospitalized patients. Ann Intern Med. 1999. 130:404–411.
5. Moran GJ, McCabe F, Morgan MT, Talan DA. Delayed recognition and infection control for tuberculosis patients in the emergency department. Ann Emerg Med. 1995. 26:290–295.
6. Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald JM, et al. Delay in diagnosis among hospitalized patients with active tuberculosis-predictors and outcomes. Am J Respir Crit Care Med. 2002. 165:927–933.
7. Zahar JR, Azoulay E, Klement E, De Lassence A, Lucet JC, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med. 2001. 27:513–520.
8. Kwon DW, Yoon YJ, Hong YP. A clinical study of patient's delay and doctor's delay in case-finding of pulmonary tuberculosis. Tuberc Respir Dis. 1987. 34:51–56.
11. Fischl MA, Uttamchandani RB, Daikos L, Poblete RB, Moreno JN, Reyes RR, et al. An outbreak of tuberculosis caused by multi-drug resistant tubercle bacilli among patients with HIV infection. Ann Intern Med. 1992. 117:177–183.
12. Pearson ML, Jereb JA, Frieden TR, Crawford JT. Nosocomial transmission of multi-drug resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Ann Intern Med. 1992. 117:191–196.
13. Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, et al. An outbreak of multi-drug resistant tuberculosis among hospitalized pat ients with the acquired immunodeficiency syndrome. N Engl J Med. 1992. 326:1514–1521.
14. Menzies RI, Fanning A, Yuan L. Tuberculosis among health care workers. N Engl J Med. 1995. 332:92–98.
15. Rodger A, Jaffar S, Paynter S, Hayward A, Carless J, Maguire H. Delay in the diagnosis of pulmonary tuberculosis, London, 1998-2000: analysis of surveillance data. BMJ. 2003. 326:909–910.
16. Lienhardt C, Rowley J, Manneh K, Lahai G, Needham D, Milligan P, et al. Factors affecting time delay to treatment in a tuberculosis control programme in a sub-Saharan African country: the experience of The Gambia. Int J Tuberc Lung Dis. 2001. 5:233–239.
17. Lawn SD, Afful B, Acheampong JW. Pulmonary tuberculosis: diagnostic delay in Ghanaian adults. Int J Tuberc Lung Dis. 1998. 2:635–640.
18. Hong NH, Johansson E, Lönnroth K, Eriksson B, Winkvist A, Diwan VK. Longer delays in tuberculosis diagnosis among women in Vietnam. Int J Tuberc Lung Dis. 1999. 3:388–393.
19. Mathur P, Sacks L, Auten G, Sall R, Levy C, Gordin F. Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med. 1994. 154:306–310.
20. Counsell SR, Tan JS, Dittus RS. Unsuspected pulmonary tuberculosis in a community teaching hospital. Arch Intern Med. 1989. 149:1274–1278.
21. Liaw Y-S, Yang P-C, Yu C-J, Wu Z-G, Chang D-B, Lee L-N, Kuo S-H, Luh K-T. Clinical spectrum of tuberculosis in older patients. JAGS. 1995. 43:256–260.
22. Dahmash NS, Fayed DF, Chowdhury MNH, Arora SC. Diagnostic challenge of tuberculosis of the elderly in hospital: experience at a university hospital in Saudi Arabia. J Infect. 1995. 31:93–97.
23. Alpert PL, Munsiff SS, Gourevitch MN, Greenberg B, Klein RS. A prospective study of tuberculosis and human immunodeficiency virus infection: clinical manifestations and factors associated with survival. Clin Infect Dis. 1997. 24:661–668.
24. Sherman LF, Fujiwara PI, Cook SV, Bazerman LB, Frieden TR. Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999. 3:1088–1095.
25. Asch S, Leake B, Anderson R, Gelberg L. Why do symptomatic patients delay obtaining care for tuberculosis. Am J Respir Crit Care Med. 1998. 157:1244–1248.
26. Dooley KE, Golub J, Goes FS, Merz WG, Sterling TR. Empiric treatment of community-acquired pneumonia with fluoroquinolones, and delays in the treatment of tuberculosis. Clin Infect Dis. 2002. 34:1607–1612.
27. Uthaivoravit W, Yanai H, Tappero JW, Limpakarnjanarat K, Srismith R, Mastro TD, et al. Impact of enhanced notification of tuberculosis laboratory results to minimize treatment delay, Chiang Rai Hospital, Northern Thailand. Int J Tuberc Lung Dis. 2003. 7:46–51.
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