Preventing nosocomial transmission of pulmonary tuberculosis: when may isolation be discontinued for patients with suspected tuberculosis?

Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
Anwer H SiddiquiMary-Claire Roghmann

Abstract

The Centers for Disease Control and Prevention and the American Thoracic Society recommend obtaining cultures of at least three sputum specimens for acid-fast bacilli (AFB) from patients in whom tuberculosis (TB) is suspected. On the basis of this, most hospitals isolate patients with suspected TB for 3 days or more until three smear (not culture) results are negative. Our objective was to evaluate the predictive value and sensitivity of these smears. Observational study. Four urban medical centers. The posttest probability of TB given sequential negative AFB smears from 274 patients isolated for suspected TB and the sensitivity of sequential AFB smears from 209 patients with positive results on culture for pulmonary TB were measured. The posttest probabilities of having TB given one, two, and three negative AFB smears were low: 1.1% (3 of 265; 95% confidence interval [CI95], 0.23% to 3.27%), 0.4% (1 of 262; CI95 0% to 2.1%), and 0% (0 of 260; CI95, 0% to 1.4%), respectively. Among the 209 patients with positive results on culture for pulmonary TB, 169 (81%) had an expectorated sputum specimen sent, of which 91 (54%) were positive for AFB. Forty (24%) of the 169 patients had a second expectorated sputum specimen sent after the ...Continue Reading

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Citations

Dec 31, 2003·Transplantation Proceedings·H Carbajal, H Cabriales
Apr 9, 2004·Journal of Clinical Microbiology·Yi-Wei TangXiaotian Zheng
Feb 5, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Lely SolariPatrick van der Stuyft
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Jul 23, 2008·British Journal of Nursing : BJN·Ann-Marie Aziz
Apr 1, 2017·Microbiology Spectrum·Sorana Segal-Maurer

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