https://scholars.lib.ntu.edu.tw/handle/123456789/493727
Title: | Impact of introducing fluorescent microscopy on hospital tuberculosis control: A before-after study at a high caseload medical center in Taiwan | Authors: | HSIN-YUN SUN JANN-YUAN WANG YEE-CHUN CHEN PO-REN HSUEH Chen Y.-H. YU-CHUNG CHUANG CHI-TAI FANG SHAN-CHWEN CHANG Wang J.-D. |
Issue Date: | 2020 | Publisher: | Public Library of Science | Journal Volume: | 15 | Journal Issue: | 4 | Source: | PLoS ONE | Abstract: | Background Undiagnosed tuberculosis (TB) patients hospitalized because of comorbidities constitute a challenge to TB control in hospitals. We aimed to assess the impact of introducing highly sensitive fluorescent microscopy for examining sputum smear to replace conventional microscopy under a high TB risk setting. Methods We measured the impact of switch to fluorescent microscopy on the smear detection rate of culture-confirmed pulmonary TB, timing of respiratory isolation, and total non-isolated infectious person-days in hospital at a high-caseload medical center (approximately 400 TB cases annually) in Taipei. Multivariable Cox regression was applied to adjust for effects of covariates. The effect attributable to the improved smear detection rate was determined using causal mediation analysis. Results After switch to fluorescence microscopy, median non-isolated infectious duration decreased from 12.5 days to 3 days (P<0.001). Compared with conventional microscopy, fluorescence microscopy increased sputum smear detection rate by two-fold (for all patients: from 22.8% to 48.1%, P<0.001; for patients with cavitary lung lesion: from 43% to 82%, P = 0.029) and was associated with a 2-fold higher likelihood of prompt respiratory isolation (odds ratio mediated by the increase in sputum smear detection rate: 1.8, 95% CI 1.3–2.5). Total non-isolated infectious patient-days in hospital decreased by 69% (from 4,778 patient-days per year to 1,502 patient-days per year). Conclusions In a high TB caseload setting, highly sensitive rapid diagnostic tools could substantially improve timing of respiratory isolation and reduce the risk of nosocomial TB transmission. ? 2020 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85082943870&doi=10.1371%2fjournal.pone.0230067&partnerID=40&md5=93c31052bd336a7fb374b044d0f2b3da https://scholars.lib.ntu.edu.tw/handle/123456789/493727 |
ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0230067 | SDG/Keyword: | adult; aged; Article; bacterium isolation; cell culture technique; diagnostic test accuracy study; disease duration; female; fluorescence microscopy; health care facility; high caseload medical center; human; infection risk; lung cavity; lung lesion; lung tuberculosis; major clinical study; male; prevalence; risk assessment; sensitivity analysis; sputum smear; Taiwan; tuberculosis control; clinical trial; epidemiology; fluorescence microscopy; lung tuberculosis; microbiology; middle aged; retrospective study; sputum; teaching hospital; Adult; Controlled Before-After Studies; Female; Hospitals, Teaching; Humans; Male; Microscopy, Fluorescence; Middle Aged; Retrospective Studies; Sputum; Taiwan; Tuberculosis, Pulmonary |
Appears in Collections: | 流行病學與預防醫學研究所 |
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