589. Factors Associated with Delayed Management of Smear-positive Pulmonary tuberculosis in Hospitalized Patients
Session: Poster Abstract Session: TB: Mycobacteria Diagnostic Testing
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • (2015) IDWEEK poster 589.pdf (309.6 kB)
  • Background: Tuberculosis (TB) is a major communicable infectious disease and nosocomial transmission is a great concern. Patients with smear-positive pulmonary tuberculosis (PTB) are the most infectious. The study is aimed to describe the  risks factors for delayed management in patients with newly diagnosed smear-positive PTB.

    Methods: The information was retrospectively collected by detailed chart review. The patients were categorized as having typical TB-related symptoms. Chest radiography findings was consdiered typical if lesions found at upper lobes, cavitory or miliary lesion. The various time intervals were recorded: admission to ordering of AFB/FLU test (doctor delay), ordering of the first AFB/FLU test to receipt of specimens by the lab (collection/transportation delay), receipt of specimens to report of the result to the clinicians (laboratory delay). 

    Results: A total of 466 patients with newly diagnosed smear-positive PTB in 5-year periods (2003-2007) were included, with mean age of 69.7 years. Doctor delay was the major cause of delay to management comparing to collection/transportation dealy and laboratory delay (43.2 vs. 16.8 vs. 26.4 hours, p<0.005). Factors associated with doctor delay were female (+21.7 hours, compared with male) and malignancy (+38.2 hours compared with patients without malignancy). Typical chest radiography findings was a protective factor that saved 33.2 hours earlier than atypical findings.  The laboratory dealy was associated with the weekdays. Delay in reporting results of acid-fast stain testing was noted in Friday (+7.8 hours) and Saturday (+13.4 hours) with Thursday as the reference. 

    Conclusion: Delay in management of patients with tuberculosis in the hospital is a critical issue. Evaluation of the factors associated with delayed management may help refine the control policy for tuberculosis in the hospitals. The study revealed patients who were female, with underlying malignancy and atypical findings on chest film may be at risk for delayed management. An uninterrupted laboratory service for management of specimens for the diagnosis of tuberculosis is also important as the data in our study showed that delays occurred in the weekend.

    Yu-Lin Li, M.D.; M.S.1, Chih-Yen Chang, M.D.2, Chun-Eng Liu, M.D.2, Yu-Ren Cheng, M.D.2, Chen-Hui Chong, M.D.2, Huei-Wen Lai, R.N.2 and I-Lun Hou, R.N.2, (1)Infectious Diseases, Changhua Christian Hospital, Changhua, Taiwan, (2)Changhua Christian Hosptial, Changhua, Taiwan

    Disclosures:

    Y. L. Li, None

    C. Y. Chang, None

    C. E. Liu, None

    Y. R. Cheng, None

    C. H. Chong, None

    H. W. Lai, None

    I. L. Hou, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.