Tuberc Respir Dis.  2006 Mar;60(3):277-284.

Delayed Treatment of Pulmonary Tuberculosis in a University Hospital

• Kang SM
• Lee JG
• Chung JH
• Han CH
• Byun MK
• Chung WY
• Park MS
• Kim YS
• Kim SK
• Chang J
• Kim SK

Abstract

BACKGROUND: Delayed treatment of pulmonary tuberculosis is an important problem because it results in greater mortality and the nosocomial transmission of tuberculosis. This study was conducted to analyze the factors that contribute to the delayed treatment of pulmonary tuberculosis in a university hospital and we wanted to provide basic data for instituting an effective management program for tuberculosis.
METHODS
we retrospectively reviewed the medical records of 155 patients with smear-positive or culture-positive pulmonary tuberculosis and who were treated between May 1999 and October 1999. A case-control study was performed to analyze the factors. We then tried to follow up the patients in delayed treatment group via telephone for the purpose of assessing the therapeutic interventions.
RESULTS
Among 150 patients, 55 (37%) were included in the delayed treatment group. The factors associated with delayed treatment on the univariate analysis included age (61 vs 40 years old; p<0.001), a smear-negative sputum test for acid-fast bacilli (AFB) (85% vs 55%; p<0.001) and no visits to a private clinic before the patient presented to the university hospital (56% vs 36%; p=0.014). Multivariate analysis revealed that old age (p=0.001), a smear-negative sputum for AFB (p=0.001), and lower lobe infiltrate on chest X-ray (p=0.041) were the independent predictors of delayed treatment. Of the 22 patients who did not receive any treatment, 20 of them 91%) consented to our suggestion of revisiting the hospital.
CONCLUSION
Delayed treatment of patients with pulmonary tuberculosis is not uncommon in a university hospital. Old age, smear-negative for AFB, and lower lobe infiltrate on chest X-ray are the risk factors for delayed treatment. A more systematic management system is required for achieving better control of tuberculosis.

Keyword

Tuberculosis; Delayed treatment

MeSH Terms

Adult
Case-Control Studies
Follow-Up Studies
Humans
Medical Records
Mortality
Multivariate Analysis
Retrospective Studies
Risk Factors
Sputum
Telephone
Thorax
Tuberculosis
Tuberculosis, Pulmonary*

Figure

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  Figure 1 Results of telephone follow-up of patients in delayed treatment group.

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