FAST tuberculosis transmission control strategy speeds the start of tuberculosis treatment at a general hospital in Lima, Peru
| Autor: | Shelley Hurwitz, Eli Orvis, Dante Vargas, Edward A. Nardell, Dylan B. Tierney, Leonid Lecca, Patricia Segura, Ruvandhi R. Nathavitharana, Karen Tintaya, Silvana de la Gala, Carole D. Mitnick |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
Pediatrics medicine.medical_specialty Tuberculosis Epidemiology Microbial Sensitivity Tests Hospitals General Tuberculosis diagnosis Pulmonary tuberculosis Peru Tuberculosis Multidrug-Resistant medicine Humans Prospective Studies General hospital Prospective cohort study Tuberculosis Pulmonary Transmission (medicine) business.industry Mycobacterium tuberculosis Drug susceptibility medicine.disease Infectious Diseases business Historical Cohort |
| Zdroj: | Infection Control & Hospital Epidemiology. 43:1459-1465 |
| ISSN: | 1559-6834 0899-823X |
| Popis: | Objective:To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.Design:Prospective cohort study with historical controls.Participants:Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.Methods:The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.Results:We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001).Conclusions:Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|