Hostname: page-component-6766d58669-fx4k7 Total loading time: 0 Render date: 2026-05-18T05:07:00.285Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventing Nosocomial Transmission of Pulmonary Tuberculosis: When may Isolation be Discontinued for Patients with Suspected Tuberculosis?

Published online by Cambridge University Press:  02 January 2015

Anwer H. Siddiqui ,
Trish M. Perl ,
Martha Conlon ,
Nancy Donegan  and
Mary-Claire Roghmann
Anwer H. Siddiqui
Affiliation:
University of Maryland School of Medicine and the VA Maryland Health Care System, Baltimore, Maryland
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Martha Conlon
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Nancy Donegan
Affiliation:
Washington Hospital Center, Washington, DC
Mary-Claire Roghmann*
Affiliation:
University of Maryland School of Medicine and the VA Maryland Health Care System, Baltimore, Maryland
*
Division of Hospital Epidemiology, VA Maryland Health Care System, 10 N. Greene Street (BT-111), Baltimore, MD 21201
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

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.

Design:

Observational study.

Setting:

Four urban medical centers.

Methods:

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.

Results:

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 results of the first specimen were negative; only 6 (15%) of these had positive AFB smears. None of the 10 patients in whom the first two expectorated sputum samples yielded an AFB smear without an organism had a third AFB smear that was positive.

Conclusion:

Unless there is high clinical suspicion of pulmonary TB in a specific patient, the use of three AFB smears on expectorated sputa is a rational approach to discontinuing isolation for patients with suspected TB.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 3 , March 2002 , pp. 141 - 144
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Blumberg, HM, Watkins, DL, Berschling, JD, et al. Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122:658–663.Google Scholar
2.Bangsberg, DR, Crowley, K, Moss, A, Dobkin, JF, McGregor, C, Neu, HC. Reduction in tuberculin skin-test conversions among medical house staff associated with improved tuberculosis infection control practices. Infect Control Hosp Epidemiol 1997;18:566–570.Google Scholar
3.Wenger, PN, Orten, J, Breeden, A, Orfas, D, Beck-Sague, CM, Jarvis, WR. Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients. Lancet 1995;345:235–240.Google Scholar
4.Kelly-Rossini, L, Perlman, DC, Mason, DJ. The experience of respiratory isolation for HIV-infected persons with tuberculosis. J Assoc Nurses AIDS Care 1996;7:29–36.CrossRefGoogle ScholarPubMed
5.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):64.Google Scholar
6.Bass, JB, Farer, LS, Hopewell, PC, Jacobs, RF, Snider, DE. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990;149:1359–1374.Google Scholar
7.Levy, H, Feldman, C, Sacho, H, van der Meulen, H, Kallenbach, J, Koornhof, H. A reevaluation of sputum microscopy and culture in the diagnosis of pulmonary tuberculosis. Chest 1989;95:1193–1197.Google Scholar
8.Dutt, AK, Stead, WW. Short-course chemotherapy: the Arkansas experience. Chest 1981;80:724–727.CrossRefGoogle ScholarPubMed
9.Greenbaum, M, Beyt, BEJ, Murray, PR. The accuracy of diagnosing pulmonary tuberculosis at a teaching hospital. Am Rev Respir Dis 1980; 121:477–481.CrossRefGoogle ScholarPubMed
10.Kim, TC, Blackman, RS, Heatwole, KM, Kim, T, Rochester, DF. Acid-fast bacilli in sputum smears of patients with pulmonary tuberculosis: prevalence and significance of negative smears pretreatment and positive smears post-treatment. Am Rev Respir Dis 1984;129:264–268.Google Scholar
11.Nelson, SM, Deike, MA, Cartwright, CP. Value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis. J Clin Microbiol 1998;36:467–469.CrossRefGoogle ScholarPubMed
12.Burken, MI, Shea, JA, Johnson, CC, Hershey, JC, Asch, DA. Comparison of sputum microscopy versus nucleic acid amplification for the presumptive diagnosis of pulmonary tuberculosis: a meta-analysis. Clinical Performance and Quality Health Care 1998;6:53–59.Google Scholar
13.Grzybowski, S, Barnett, GD, Styblo, K. Contacts of cases of active pulmonary tuberculosis. Bulletin of the International Union for Tuberculosis 1975;50:90–106.Google Scholar
14.Behr, MA, Warren, SA, Salamon, H, et al. Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli. Lancet 1999;353:444–449.Google Scholar