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Do Resident Physicians Agree with LTBI Treatment Guidelines?

Session: Poster Abstract Session: Mycobacterial Infection: Screening and Diagnosis
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Previous studies have demonstrated that foreign-born physicians in the U.S. are less accepting of latent tuberculosis infection (LTBI) treatment among themselves and their patients. It is uncertain whether these differences are motivated by differences in medical education or by cultural beliefs regarding BCG vaccination. Our objective was to determine whether a resident physician’s decision to treat LTBI under various scenarios was associated with their personal history of BCG vaccination.

Methods: We surveyed internal medicine residents from an single academic medical center regarding their personal history of LTBI, as well as their attitudes towards LTBI diagnosis and treatment in their patients. We queried country of birth, year of birth, and country of medical school training. The BCG World Atlas ( was used to ascertain the personal history of BCG vaccination for all respondents, based on country and year of birth.

Results: 37 of 60 residents (62%) responded to the survey. Among 23 respondents born outside the U.S., 18 (78%) were assigned a history of BCG vaccination. There were 6 respondents with a personal history of LTBI, and 2 of 6 (33%) reported completing treatment. One respondent had a personal history of pulmonary TB. Among 30 respondents without a history of LTBI, 22 (73%) would accept LTBI treatment based on a positive TST, while 26 (87%) would accept treatment based on a positive IGRA (p=0.2). Overall, 17 of 37 respondents (46%) would recommend LTBI treatment for a BCG-vaccinated individual with a first-ever positive TST, increasing to 86% (32/37) for a first-ever positive IGRA in a BCG-vaccinated individual (p<0.01). In contrast, there was no difference in attitudes towards treating a converted TST (32/37, 86%) or IGRA (33/37, 89%) in BCG-vaccinated individuals. Contrary to our hypothesis, we did not find a significant relationship between a resident physician’s personal history of BCG vaccination and LTBI treatment attitudes.

Conclusion: A resident’s personal history of BCG vaccination was not associated with acceptance of LTBI treatment in their patients. Further work is needed to define both the cultural and educational factors that motivate attitudes towards LTBI treatment among resident physicians.

Arun Janakiraman, MD, Medicine, Cooper University Hospital, Camden, NJ, Franklin Yates, MD, Infectious Diseases, Drexel University College of Medicine / Hahnemann University Hospital, Philadelphia, PA, Anna Headly, MD, Cooper University Hospital, Camden, NJ, Darren R. Linkin, MD, MSCE, University of Pennsylvania School of Medicine, Philadelphia, PA and Christopher Vinnard, MD, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA


A. Janakiraman, None

F. Yates, None

A. Headly, None

D. R. Linkin, None

C. Vinnard, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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