346. Failure to Isolate Patients with Tuberculosis as a Patient Safety Issue: A Retrospective, case control, multicenter study in 4 South Texas centers
Session: Poster Abstract Session: HAI: Outbreaks
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Final Poster IDSA.pdf (1.1 MB)
  • Background: Healthcare associated tuberculosis (TB) exposure cohorts, continue to occur, and are frequently not recognized. Data on clinical features from TB cases leading to exposure cohorts is scarce

    Methods: This was a retrospective, case control, multicenter study investigating the cases of TB resulting in exposure at four healthcare systems in Texas. Patients with a microbiological diagnosis of TB were divided into cases (resulting in a TB exposure cohort) vs controls (not resulting in an exposure cohort).  Demographic, clinical and epidemiological features of were compared between groups

    Results:

    From 01/2005 to 12/2012, there were 336 active TB infections included.  Parkland represented the major number (N=171, 51%), followed by UH San Antonio (N=132, 39.4%), STVHCS (N=22, 6.5%) and Central Texas VA (N=10, 2.8%).  Patients were grouped into cases (N=199) or controls (N=137). The mean time until isolation for cases was variable 13±11.7 hours vs. 2.04±4.62 hours for controls (p<0.01).

    Cases were less likely to be admitted by teaching service (78% vs. 88% P value <0.01).  In bivariate analysis, case and controls were not significantly different in regards mean age, gender and comorbidities, use of alcohol, tobacco, illicit drugs nor history of treated latent TB.

    Cases were less likely to have history of treated active TB (6% vs 13%, p=0.03), more likely to have typical TB findings on chest X rays (83.4% vs 60.6%, p<0.01), more likely to have isolated pulmonary TB than controls (89% vs. 64%, p<0.01). Cases were less likely to have extrapulmonary TB (11% vs 36%, p<0.01).

    On multivariable analysis,  cases were less likely to have extrapulmonary disease (OR: 0.35, 95% CI: 0.18-0.67), history of previous active TB (OR: 0.25, 95% CI 0.1-0.64), and more likely to have diabetes mellitus (OR:2.1, 95% CI: 1-4.5), HIV (OR 3.15, 95% CI: 1.41-7.06), transplant (OR 13.33, 95% CI 1.35-131.23) and typical TB X rays findings (OR: 3.04, 95% CI: 1.59-5.83). 

    Conclusion: Despite decreasing incidence of TB cases, TB exposure cohorts continue to be common in academic centers in Texas. Protective risk factors for TB exposure cohorts were admission to a teaching service, known history of previously treated TB and TB cases with extra-pulmonary compromise

    Norys a. Castro-Pena, MD, Infectious Disease, University of Texas at san antonio, San Antonio, TX, Jose Cadena, MD, South Texas Veterans Healthcare System, San Antonio, TX, Joel Michalek, PHD, University of Texas San Antonio, San Antonio, TX, Heta Javeri, MD, MPH, Infectious Disease, University of Texas Health Science Center San Antonio, San Antonio, TX, Jason E. Bowling, MD, University Health System, San Antonio, TX, Miloni Shroff, MD, MPH, Infectious Diseases, University of Texas- Southwestern Medical Center, Dallas, TX, Pranavi Sreeramoju, MD, MPH, University of Texas Southwestern Medical Center, Dallas, TX, Chetan Jinadatha, MD, MPH, Infectious Disease Division, Central Texas Veterans Health Care System, Temple, TX, Gustavo Valero, MD, Texas Valley Coastal Bend Health Care System, Harlingen, TX, Jean Przykucki, RN, South Texas Veterans Health Care System, San Antonio, TX and James Jorgensen, PhD, FIDSA, University of Texas Health Sciences Center, San Antonio, TX

    Disclosures:

    N. A. Castro-Pena, None

    J. Cadena, None

    J. Michalek, None

    H. Javeri, None

    J. E. Bowling, None

    M. Shroff, None

    P. Sreeramoju, None

    C. Jinadatha, Xenex Healthcare Service: Principal Investigator on a cooperative research agreement between Department of Veterans Affairs and Xenex Healthcare Services. The study laboratory activity was supported by a grant from Xenex Healthcare Services. , Laboratory Activity Support

    G. Valero, None

    J. Przykucki, None

    J. Jorgensen, None

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