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Delayed Treatment of Pulmonary Tuberculosis in a University Hospital  

Kang, Shin Myung (Department of Internal Medicine, Yonsei University College of Medicine)
Lee, Jun Gu (Department of Internal Medicine, Yonsei University College of Medicine)
Chung, Jae Ho (Department of Internal Medicine, KwandongUniversity College of Medicine, Myongji hospital)
Han, Chang Hoon (Department of Internal Medicine, Yonsei University College of Medicine)
Byun, Min Kwang (Department of Internal Medicine, Yonsei University College of Medicine)
Chung, Wou Youn (Department of Internal Medicine, Yonsei University College of Medicine)
Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine)
Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine)
Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
Chang, Joon (Department of Internal Medicine, Yonsei University College of Medicine)
Kim, Sung Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.60, no.3, 2006 , pp. 277-284 More about this Journal
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.
Keywords
Tuberculosis; Delayed treatment;
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