Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit

Ahn, Jong Gyun; Kim, Dong Soo; Kim, Ki Hwan

doi:10.1016/j.ajic.2015.07.020

Cited by 20 publications

(23 citation statements)

References 20 publications

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“…Although it is desirable to preemptively isolate patients with pneumonia of unknown cause, it is difficult to implement preemptive isolation in the real world unless there is clear evidence of PTB. Many cases of nosocomial transmission of PTB have been reported in Korea 1112. Early diagnosis, isolation, and treatment are essential for an effective TB control program.…”

Section: Discussionmentioning

confidence: 99%

Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea

et al. 2019

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Background: Delays in isolating patients admitted to hospital with active pulmonary tuberculosis (PTB) can contribute to nosocomial transmission; however, in Korea, patients with clinically diagnosed PTB are not routinely isolated while awaiting microbiological confirmation of the diagnosis. We aimed to assess the extent of delays in isolating patients admitted with PTB and to identify the factors associated with delayed isolation. Methods: We retrospectively reviewed the electronic medical records of patients aged ≥ 18 years with active PTB, between January 2008 and December 2017, from two Korean hospitals. Results: Among 1,062 patients, 612 (57.6%) were not isolated on admission day. The median time from admission to isolation was 1 day (interquartile range: 0-2 days). The independent risk factor most strongly associated with delayed isolation was admission to departments other than pulmonology or infectious diseases departments (adjusted odds ratio [aOR], 5.302; 95% confidence interval [CI], 3.177-8.847; P < 0.001). Factors associated with isolation on admission day were a past history of tuberculosis (TB) (aOR, 0.669; 95% CI, 0.494-0.906; P = 0.009), night sweats (aOR, 0.530; 95% CI, 0.330-0.851; P = 0.009), and apical infiltrates on chest radiographs (aOR, 0.452; 95% CI, 0.276-0.740; P = 0.002). Conclusion: Concerning patients subsequently diagnosed with active PTB, > 50% were not isolated on admission day. We suggest that the patients with clinically suspected PTB including the elderly who have a past history of TB, night sweats, or apical infiltration on chest radiographs, be presumptively isolated on admission, without waiting for microbiological confirmation of the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea

et al. 2019

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“…Medical contraindications (medical instability/elevated transaminases). 38 …”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies documented screening of paediatric patients at high risk of TB infection because of exposure in healthcare settings, 38 44 the community 28 29 33 41 45–52 and schools. 36 53–60 Additionally, 12 studies reported screening groups with a high population prevalence of TB infection, such as newly arrived asylum seekers, immigrants and refugees, 37 61–64 and students from high-risk populations.…”

Section: Resultsmentioning

confidence: 99%

A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking

2021

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Background and objectivesIdentifying and treating children with latent tuberculosis infection (TB infection) is critical to prevent progression to TB disease and to eliminate TB globally. Diagnosis and treatment of TB infection requires completion of a sequence of steps, collectively termed the TB infection care cascade. There has been no systematic attempt to comprehensively summarise literature on the paediatric TB infection care cascade.MethodsWe performed a scoping review of the paediatric TB infection care cascade. We systematically searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane and Embase databases. We reviewed articles and meeting abstracts that included children and adolescents ≤21 years old who were screened for or diagnosed with TB infection, and which described completion of at least one step of the cascade. We synthesised studies to identify facilitators and barriers to retention, interventions to mitigate attrition and knowledge gaps.ResultsWe identified 146 studies examining steps in the paediatric TB infection care cascade; 31 included children living in low-income and middle-income countries. Most literature described the final cascade step (treatment initiation to completion). Studies identified an array of patient and caregiver-related factors associated with completion of cascade steps. Few health systems factors were evaluated as potential predictors of completion, and few interventions to improve retention were specifically tested.ConclusionsWe identified strengths and gaps in the literature describing the paediatric TB infection care cascade. Future research should examine cascade steps upstream of treatment initiation and focus on identification and testing of at-risk paediatric patients. Additionally, future studies should focus on modifiable health systems factors associated with attrition and may benefit from use of behavioural theory and implementation science methods to improve retention.

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“…There have been improvements in the early detection of active TB cases and prevention of its transmission at schools. However, continued TB outbreaks at various congregate settings, such as neonatal intensive care units and postpartum care centres, have become a social issue 20 21. As the problem became more prominent, the Korean government has regarded TB incidence in congregate settings as a serious problem and made efforts to it more actively.…”

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis infection screening and treatment in congregate settings (TB FREE COREA): protocol for a prospective observational study in Korea

et al. 2020

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IntroductionSouth Korea regards tuberculosis (TB) incidence in congregate settings as a serious problem. To this end, systematic latent TB infection (LTBI) diagnosis and treatment were provided to approximately 1.2 million individuals in high-risk congregate settings.Methods and analysisWe designed a prospective cohort study of individuals tested for LTBI, based on the data collected on all persons screened for LTBI as part of the 2017 congregate settings programme in South Korea. Four types of databases are kept: LTBI screening database (personal information and LTBI test results), national health information (NHI) database (socio-demographic data and comorbidities), public healthcare information system (PHIS) database, and the Korean national TB surveillance system database (TB outcomes). Information regarding LTBI treatment at private hospitals and public health centres is collected from NHI and PHIS databases, respectively. The screening data are cleaned, duplicates are removed, and, where appropriate, re-coded to analyse specific exposures and outcomes. The primary objective is to compare the number of active TB cases prevented within 2 years between participants undergoing treatment and not undergoing treatment in the LTBI screening programme in congregate settings. Cascade of care for LTBI diagnosis and treatment will be evaluated among those with a positive LTBI test result. A Cox proportional hazards model will be applied to determine the risk factors for developing active TB.Ethics and disseminationThe protocol is approved by the institutional review boards of Incheon St. Mary’s Hospital, the Catholic University of Korea. Study results will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberKCT0003905

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Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit

Cited by 20 publications

References 20 publications

Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea

Delays in Isolating Patients Admitted to Hospital with Pulmonary Tuberculosis in Korea

A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking

Latent tuberculosis infection screening and treatment in congregate settings (TB FREE COREA): protocol for a prospective observational study in Korea

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