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Management and Outcome of Tuberculosis in Two St Louis Hospitals, 1988 to 1994

  • Paul B. L'Ecuyer (a1) (a2), Keith F. Woeltje (a2), Sondra M. Seiler (a2) and Victoria J. Fraser (a2)

Abstract

Objective:

To describe management and outcome of tuberculosis (TB) and current practices for isolation in two urban hospitals in the Midwest.

Design:

Retrospective cohort study.

Setting:

Barnes Hospital and Jewish Hospital, tertiary-care and community hospitals affiliated with Washington University School of Medicine in St Louis, Missouri.

Patients:

All adult patients with a positive culture for Mycobacterium tuberculosis from 1988 to 1994.

Results:

We identified 122 cases at Barnes and Jewish Hospitals (36.5/100,000 hospital discharges), median age was 59.0 years, 61.5% were non-Caucasian, and 54.9% resided within the city limits. Underlying risk conditions were common: substance abuse (25%), recent TB contact (24%), and foreign birth (13%). Coexistent human immunodeficiency virus infection (8%) was uncommon. Of skin-tested cases, 22% were anergic; of the rest, 22% tested negative. Almost 20% of cases had prior positive skin tests, and thus were preventable, but had not received adequate prophylaxis. Of hospitalized patients with pulmonary TB, 70% received respiratory isolation. Antibiotic resistance was recognized in 16%; only 19% of cases initially received four-drug therapy. TB-related death occurred in 16%.

Conclusions:

In this area, TB cases primarily involve traditional risk groups without HIV coinfection. Current infection control practices, diagnostic strategies, and initial treatment regimens are suboptimal. Education about local disease epidemiology is needed to prevent nosocomial TB transmission.

Copyright

Corresponding author

Division of Infectious Diseases, Box 8051, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110

References

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1.Rieder, HL, Cauthen, GM, Kelly, GD, Bloch, AB, Snider, DE. Tuberculosis in the United States. JAMA 1989;262:385389.
2.Barnes, PF, Barrows, SA. Tuberculosis in the 1990s. Ann Intern Med 1993;119:400410.
3.Centers for Disease Control and Prevention. Initial therapy for tuberculosis in the era of multidrug resistance: recommendations of the Advisory Council for the Elimination of Tuberculosis. JAMA 1993;270:694698.
4.Ravligione, MC, Snider, DE, Kochi, A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995;273:220226.
5.Centers for Disease Control and Prevention. Tuberculosis morbidity—United States, 1995. MMWR 1996;45:365370.
6.McKenna, MT, McCray, E, Onorato, I. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986-1993. N Engl J Med 1995;332:10711076.
7.Ellner, JJ, Hinman, AR, Dooley, SW, Fischl, MA, Sepkowitz, KA, Goldberger, MJ, et al.Tuberculosis symposium: emerging problems and promise. J Infect Dis 1993;168:537551.
8.Bloom, BR, Murray, CJ. Tuberculosis: commentary on a reemergent killer. Science 1992;257:10551064.
9.Fischl, MA, Uttamchandani, RB, Daikos, GL, Poblete, RB, Moreno, JN, Reyes, RR, et al.An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992;117:177183.
10.Dooley, SW, Villarino, ME, Lawrence, M, Salinas, L, Amil, S, Rullan, JV, et al.Nosocomial transmission of tuberculosis in a hospital unit for HIV- infected patients. JAMA 1992;267:26322635.
11.Di Perri, G, Cadeo, G, Castelli, F, Micciolo, R, Bassetti, S, Rubini, F, et al.Transmission of HIV-associated tuberculosis to healthcare workers. Infect Control Hosp Epidemiol 1993;14:6772.
12.Catanzaro, A. Nosocomial tuberculosis. Am Rev Respir Dis 1982;125:559562.
13.Centers for Disease Control and Prevention. Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988-1991. MMWR 1991;40:585591.
14.Frieden, TR, Sherman, LF, Maw, KL, Fujiwara, PI, Crawford, JT, Nivin, B, et al.A multi-institutional outbreak of highly drug-resistant tuberculosis. JAMA 1996;276:12291235.
15.Pearson, ML, Jereb, JA, Frieden, TR, Crawford, JT, Davis, BJ, Dooley, SW, et al.Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and healthcare workers. Ann Intern Med 1992;117:191196.
16.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities, 1994. MMWR 1994;43:1132.
17.Friedman, LN, Williams, MT, Singh, TP, Frieden, TR. Tuberculosis, AIDS, and death among substance abusers on welfare in New York City. N Engl J Med 1996;334:828833.
18.Lloveras, J, Peterson, PK, Simmons, RL, Najarian, JS. Mycobacterial infections in renal transplant recipients. Arch Intern Med 1982;141:888892.
19.Kline, SE, Hedemark, LL, Davies, SF. Outbreak of tuberculosis among regular patrons of a neighborhood bar. N Engl J Med 1995;333:222227.
20.Stead, WW, Senner, JW, Reddick, WT, Lofgren, JP. Racial differences in susceptibility to infection by Mycobacterium tuberculosis. N Engl J Med 1990;322:422427.
21.Frieden, TR, Sterling, T, Pablos-Mendez, A, Kilburn, JO, Cauthen, GM, Dooley, SW. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med 1993;328:521526.
22.Missouri Department of Health. Tuberculosis 1995 annual report. Missouri Epidemiologist 1996;18(3):10-12, 35.
23.St Louis City Department of Health. HIV/AIDS Surveillance Newsletter. 12, 1995.
24.Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology Press; 1995.
25.Pablos-Mendez, A, Sterling, TR, Frieden, TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 1996;276:12231228.
26.Vas, SI. Renaissance of tuberculosis in the 1990s: lessons for the nephrologist. Peritoneal Dialysis International 1994;14:209214.
27.Mitwalli, A. Tuberculosis in patients on maintenance dialysis. Am J Kidney Dis 1991;18:579582.
28.Kwan, JT, Hart, PD, Raftery, MJ, Cunningham, J, Marsh, FP. Mycobacterial infection is an important infective complication in British Asian dialysis patients. J Hosp Infect 1991;19:249255.
29.Rutsky, EA, Rostand, SG. Mycobacteriosis in patients with chronic renal failure. Arch Intern Med 1980;140:5761.
30.Andrew, OT, Schoenfeld, PY, Hopewell, PC, Humphreys, MH. Tuberculosis in patients with end-stage renal disease. Am J Med 1980;68:5965.
31.Diego, J, Lauber, J, Fraser, VF. Tuberculosis in a chronic hemodialysis center. Infect Control Hosp Epidemiol 1995;16(suppl):36.
32.Winters, RE. Guidelines for preventing the transmission of tuberculosis: a better solution? Clin Infect Dis 1994;19:309310.
33.McGowan, JE. Resurgent nosocomial tuberculosis: consequences and actions for hospital epidemiologists. Infect Control Hosp Epidemiol 1992;13:575578.
34.Lai, KK, Fontecchio, SA, Kelley, AL, Melvin, ZS. Knowledge of the transmission of tuberculosis and infection control measures for tuberculosis among healthcare workers. Infect Control Hosp Epidemiol 1996;17:168170.
35.American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990;142:725735.
36.American Thoracic Society. Treatment of tuberculosis and tuberculosis infections in adults and children. Am J Respir Crit Care Med 1994;149:13591374.
37.Bloch, AB, Cauthen, GM, Onorato, IM, Dansbury, KG, Kelly, GD, Driver, CR, et al.Nationwide survey of drug-resistant tuberculosis in the United States. JAMA 1994;271:665671.
38.Nardell, EA, Brickner, PW. Tuberculosis in New York City: focal transmission of an often fatal disease. JAMA 1996;276:12591260.
39.Goble, M, Iseman, MD, Madsen, LA, Waite, D, Ackerson, L, Horsburgh, CR Jr.Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med 1993;328:527532.
40.Stoneburner, R, Laroche, E, Prevots, R, Singh, T, Blum, S, Terry, P, et al.Survival in a cohort of human immunodeficiency virus-infected tuberculosis patients in New York City: implications for the expansion of the AIDS case definition. Arch Intern Med 1992;152:20332037.
41.Fischl, MA, Daikos, GL, Uttamchandani, RB, Poblete, RB, Moreno, JN, Reyes, RR, et al.Clinical presentation and outcome of patients with HIV infection and tuberculosis caused by multiple-drug-resistant bacilli. Ann Intern Med 1992;117:184190.
42.Braun, MM, Cote, TR, Rabkin, CS. Trends in death with tuberculosis during the AIDS era. JAMA 1993;269:28652868.
43.Missouri Department of Health. Directly observed therapy for tuberculosis patients. Missouri Epidemiologist 1996;18(2):18-19, 21.

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