Background: Japan has the high incidence of tuberculosis with the rapid population aging in developed county. In acute care hospital, delaying in respiratory isolation for tuberculosis can cause serious hospital-acquired infections and subsequent delay in the initiation of treatment, which might be poor prognosis for not only the patient but also the around medical providers. However, there have been few studies with respect to the factors associated with delay in tuberculosis isolation in Japanese acute care hospital. We identified the factors affecting the delay in the patients with tuberculosis from patient admission until the respiratory isolation.
Methods: For consecutive patients who were smear positive for tuberculosis from January 2008 to August 2015 in our hospital, we retrospectively analyzed the factors associated with days until the respiratory isolation. As independent variables, age, gender, weekday or weekend admission, daytime or nighttime admission, means of transfer to the hospital, physician for patient care on arrival, and department of inpatient care were obtained. Day-to-respiratory isolation was analyzed by Cox proportional hazards model.
Results: Of 56 patients (median age, 83 years; 15 (73%) male), 28 (50%) patients were 80s, 13 (23%) patients were 70s, and 10 (18%) patients were 90s. Among them, 20 (36%) patients complained fever, 14 (25%) patients complained dyspnea, and 9 (16%) patients complained fatigue or malaise. In addition, 44 (79%) patients had been hospitalized through the caring for emergency medicine. Median day to respiratory isolation was 2 day (range, 1-87). The day to respiratory isolation was significant delayed for respiratory isolation in male patients (hazard ratio 2.0, 95% CI 1.0-3.8).
Conclusions: Our study revealed the factor associated with the delay in the respiratory isolation for tuberculosis was male gender. Thus, physician need considering of sputum investigation in patient with lower respiratory symptoms including cough and sputum, especially among male gender, to early respiratory isolation in patients with smear positive tuberculosis.