Journal of the Formosan Medical Association
Volume 109, Issue 4 , Pages 269-277, April 2010

Why is In-hospital Diagnosis of Pulmonary Tuberculosis Delayed in Southern Taiwan?

  • Chun-Yu Lin

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung, Taiwan
    • Chun-Yu Lin and Wei-Ru Lin contributed equally to this work.
    • ,
  • Wei-Ru Lin

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
    • Department of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Chun-Yu Lin and Wei-Ru Lin contributed equally to this work.
    • ,
  • Tun-Chieh Chen

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung, Taiwan
    • ,
  • Po-Liang Lu

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung, Taiwan
    • ,
  • Pei-Ming Huang

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
    • ,
  • Zhong-Rong Tsai

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
    • ,
  • Ming-Shyan Huang

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
    • ,
  • Wen-Cheng Tsai

      Affiliations

    • Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
    • ,
  • Yen-Hsu Chen

      Affiliations

    • Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, College of Medicine, Kaohsiung, Taiwan
    • Tropical Medicine Research Institute, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Yen-Hsu Chen, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan

Received 16 February 2009; received in revised form 8 June 2009; accepted 2 July 2009.

Article Outline

Background/Purpose

In-hospital diagnosis delay (IHDD) of pulmonary tuberculosis (TB) has a significant impact on nosocomial TB transmission. We investigated the risk factors associated with prolonged IHDD in Taiwan, a high-resource, mid-incidence area.

Methods

Between January 2005 and August 2006, we retrospectively enrolled 193 consecutive hospitalized patients. All of them had culture-proven pulmonary TB and did not receive antitubercular treatment at admission. IHDD was defined as the interval between admission and initiation of antitubercular treatment. Patients were grouped according to the median value of IHDD.

Results

The median IHDD was 7 days. Patients with IHDD > 7 days were considered the prolonged-delay group, and those with IHDD £ 7 days, the short-delay group. Independent risk factors [with adjusted odd ratios (95% confidence intervals)] for prolonged IHDD were: negative sputum smear [47.53 (13.20–171.18), p < 0.001]; non-cavitary lesions on chest radiographs [14.90 (3.46–64.14), p < 0.001]; admission to hospital departments other than chest medicine/infectious diseases [6.60 (1.95–22.41), p = 0.002]; exposure to fluoroquinolones before antitubercular treatment [5.29 (1.13–24.75), p = 0.034]; underlying malignancy [4.59 (1.13–18.67), p = 0.033); and age > 65 years [3.19 (1.01–10.05), p = 0.048]. Death attributed to tuberculosis was associated with positive sputum smear (hazard ratio = 21.85; 95% CI = 2.74–174.44; p = 0.004) but not prolonged IHDD (p = 0.325).

Conclusion

To minimize IHDD, clinicians should carefully manage hospitalized patients with risk factors for prolonged delay, such as those with negative sputum smears, non-cavitary lesions on chest radiographs, admission to departments other than chest medicine/infectious diseases, exposure to fluoroquinolones before antitubercular treatment, underlying malignancy, and age > 65 years.

Key Words:  delayed diagnosis , fluoroquinolones , malignancy , risk factors , tuberculosis

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PII: S0929-6646(10)60052-6

doi:10.1016/S0929-6646(10)60052-6

Journal of the Formosan Medical Association
Volume 109, Issue 4 , Pages 269-277, April 2010

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