Delays in tuberculosis isolation and suspicion among persons hospitalized with HIV-related pneumonia.

Autor:	Bennett CL; The Chicago VA Health Care System/Lakeside and Westside Divisions, Loyola University Medical Center, Chicago, IL 60611, USA. chenne@nwu.edu, Schwartz DN, Parada JP, Sipler AM, Chmiel JS, DeHovitz JA, Goetz MB, Weinstein RA
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2000 Jan; Vol. 117 (1), pp. 110-6.
DOI:	10.1378/chest.117.1.110
Abstrakt:	Background: Despite awareness of HIV-related tuberculosis (TB), nosocomial outbreaks of multidrug-resistant TB among HIV-infected individuals occur. Objective: To investigate delays in TB isolation and suspicion among HIV-infected inpatients discharged with TB or Pneumocystis carinii pneumonia (PCP), common HIV-related pneumonias. Design: Cohort study during 1995 to 1997. Setting: For PCP, 1,227 persons who received care at 44 New York City, Chicago, and Los Angeles hospitals. For TB, 89 patients who received care at five Chicago hospitals. Measurements: Two-day rates of TB isolation/suspicion. Results: For HIV-related PCP, Los Angeles hospitals had the lowest 2-day rates of isolation/suspicion of TB (24.3%/26.6% vs 65.5%/66.4% for New York City and 62.8%/58.3% for Chicago, respectively; p < 0.001 for overall comparison by chi(2) test for each outcome measure). Within cities, hospital isolation/suspicion rates varied from < 35 to > 70% (p < 0.001 for interhospital comparisons in each city). The Chicago hospital with a nosocomial outbreak of multidrug-resistant TB from 1994 to 1995 isolated 60% of HIV-infected individuals who were discharged with a diagnosis of HIV-related TB and 52% discharged with HIV-related PCP, rates that were among the lowest of all Chicago hospitals in both data sets. Conclusion: Low 2-day rates of TB isolation/suspicion among HIV-related PCP patients were frequent. One Chicago hospital with low 2-day rates of TB isolation/suspicion among persons with HIV-related PCP also had low 2-day rates of isolation/suspicion among confirmed TB patients. That hospital experienced a nosocomial multidrug-resistant TB outbreak. Educational efforts on the benefits of early TB suspicion/isolation among HIV-infected pneumonia patients are needed.
Databáze:	MEDLINE
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