Delays in Tuberculosis Isolation and Suspicion Among Persons Hospitalized With HIV-Related Pneumonia

• Published in: Chest Vol. 117; no. 1; pp. 110 - 116
• Main Authors: Bennett, Charles L., Schwartz, David N., Parada, Jorge P., Sipler, Alison M., Chmiel, Joan S., DeHovitz, Jack A., Goetz, Matthew B., Weinstein, Robert A.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.01.2000; American College of Chest Physicians
• Subjects: Acquired immune deficiency syndrome; AFB = acid-fastbacilli; AIDS; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - prevention & control; AIDS-Related Opportunistic Infections - transmission; AIDS/HIV; Biological and medical sciences; CDC = Centers for Disease Control and Prevention; Chicago - epidemiology; Cities; Cross Infection - epidemiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease control; Disease Outbreaks - prevention & control; Disease prevention; Epidemics; HIV; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Human immunodeficiency virus; Humans; ICD = International Classification of Diseases; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Incidence; Los Angeles - epidemiology; MDRTB = multidrug-resistant TB; Medical sciences; New York City - epidemiology; nosocomial outbreak of tuberculosis; Patient Isolation; Patients; patterns of care; PCP = Pneumocystis cariniipneumonia; Pneumonia; Pneumonia, Pneumocystis - epidemiology; Public health; quality of care; Retrospective Studies; TB = tuberculosis; Time Factors; Tuberculosis; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - prevention & control; Tuberculosis, Multidrug-Resistant - transmission; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - prevention & control; Tuberculosis, Pulmonary - transmission; New York City; Chicago; Los Angeles; Los Angeles California; Chicago Illinois; United States > US; New York City New York; ICD = International Classification of Diseases; TB = tuberculosis; CDC = Centers for Disease Control and Prevention; nosocomial outbreak of tuberculosis; patterns of care; MDRTB = multidrug-resistant TB; quality of care; PCP = Pneumocystis cariniipneumonia; AFB = acid-fastbacilli; Human; Immunopathology; Lung disease; Nosocomial infection; Opportunistic infection; Respiratory disease; Lung; Exploration; AIDS; Hospitalization; Mycobacterial infection; Immune deficiency; Bacteriological investigation; Infection; Tuberculosis; Viral disease; Bacteriosis; Complication; Diagnosis
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.117.1.110

Despite awareness of HIV-relatedtuberculosis (TB), nosocomial outbreaks of multidrug-resistant TB amongHIV-infected individuals occur. Toinvestigate delays in TB isolation and suspicion among HIV-infectedinpatients discharged with TB or Pneumocystis cariniipneumonia (PCP), common HIV-related pneumonias. Cohort study during 1995 to 1997. For PCP, 1,227 persons who received care at 44 New York City, Chicago, and Los Angeles hospitals. For TB, 89patients who received care at five Chicago hospitals. Two-day rates of TB isolation/suspicion. For HIV-related PCP, Los Angeles hospitals had thelowest 2-day rates of isolation/suspicion of TB (24.3%/26.6% vs65.5%/66.4% for New York City and 62.8%/58.3% for Chicago, respectively; p < 0.001 for overall comparison by χ2test for each outcome measure). Within cities, hospitalisolation/suspicion rates varied from < 35 to > 70% (p < 0.001for interhospital comparisons in each city). The Chicago hospital witha nosocomial outbreak of multidrug-resistant TB from 1994 to 1995isolated 60% of HIV-infected individuals who were discharged with adiagnosis of HIV-related TB and 52% discharged with HIV-related PCP, rates that were among the lowest of all Chicago hospitals in both datasets. Low 2-day rates of TBisolation/suspicion among HIV-related PCP patients were frequent. One Chicago hospital with low 2-day rates of TB isolation/suspicion amongpersons with HIV-related PCP also had low 2-day rates ofisolation/suspicion among confirmed TB patients. That hospitalexperienced a nosocomial multidrug-resistant TB outbreak. Educationalefforts on the benefits of early TB suspicion/isolation amongHIV-infected pneumonia patients are needed.