Risk factors for non-isolation of patients admitted for pulmonary tuberculosis in a high-incidence department: a single-centre retrospective study

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-10-10 DOI:10.1016/j.jhin.2024.09.020

S. Oubbéa , B. Pilmis , D. Seytre , A. Lomont , T. Billard-Pomares , J-R. Zahar , L. Foucault-Fruchard

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Abstract

Background

Pulmonary tuberculosis (PTB) is an airborne disease, warranting the identification of suspected cases on admission, and their hospitalization in individual rooms with the implementation of airborne supplementary precautions (ASPs).

Aim

To identify the frequency of non-isolated PTB and the factors associated with the delay in implementing ASPs in a high-prevalence hospital.

Methods

This retrospective observational study included patients with at least one Mycobacterium tuberculosis-positive specimen. Patient demographic and clinical data, as well as data related to the mode of admission, were collected. Univariate and multi-variate statistical analyses were performed.

Findings

During the study period, 256 patients were included. Among them, 134 (52.3%) had PTB (75% males, median age 39 years, 70% foreign-born). Among these patients, 46 (34%) were isolated beyond 24 h of admission. The average time to implement ASPs was 4.3 days, and seven patients (5.2%) were not isolated throughout their hospital stay. Multi-variate analysis indicated that three factors were associated with isolation. Previous consultation with a general practitioner was associated with greater likelihood of isolation, whereas admission through the emergency department was not. The presence of so-called ‘cardinal clinical signs’ and a suggestive chest x-ray were also associated with greater likelihood of isolation. Finally, European patients were isolated less frequently than foreign-born patients.

Conclusion

In this study, 34% of patients admitted with PTB were not isolated on admission. The likelihood of non-isolation was three times higher in cases admitted via the emergency department, and European patients were isolated less frequently than foreign-born patients. The presence of cardinal signs and prior consultation with a general practitioner were associated with greater likelihood of isolation.

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一个高发省份肺结核住院病人未隔离的风险因素：一项单中心回顾性研究。

肺结核（PT）是一种通过空气传播的疾病，因此有理由在可疑患者入院时对其进行识别，并在其住院期间在单人病房实施空气传播补充预防措施（ASP）。本研究的目的是在一家高发病率医院中确定非隔离型肺结核的发病率以及与延迟实施 ASP 相关的因素。这是一项回顾性观察研究，研究对象包括至少有一份结核分枝杆菌阳性标本的患者。研究收集了患者的人口统计学和临床数据，以及与入院方式相关的数据。进行了单变量和多变量统计分析。在研究期间，共纳入了 256 名患者。其中 134 人（52.3%）患有 PT。其中包括 100 名（75%）男性，中位年龄为 39 岁，70% 在国外出生。在这些患者中，有 46 人（34%）在入院 24 小时后仍被隔离。实施 ASP 的平均时间为 4.3 天，有 7 名患者（5.2%）在整个住院期间未被隔离。通过多变量分析，有三类因素与隔离有关。曾向全科医生就诊具有保护作用，而通过急诊科入院则不具有保护作用。存在所谓的主要临床症状和胸部 X 光片提示也是保护因素。最后，欧洲病人较少被隔离。在我们的研究中，34% 的 PT 患者在入院时未被隔离。经急诊科入院的患者未被隔离的风险是经急诊科入院的患者的三倍，而欧裔患者的隔离率较低。出现主要体征和事先咨询全科医生与较高的隔离频率有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.