Delayed Treatment and Management of Active Tuberculosis in a Medical Center in Taiwan

台灣一醫學中心活動性肺結核病患住院時延遲性治療及處置之分析

徐川洲(Chuang-Chou Tu) ； 沈光漢(Gwan-Han Shen) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 20卷6期 (2005/12) Pp. 517-523

https://doi.org/10.29806/TM.200512.0002

摘要

Mycobacterium tuberculosis infection remains an important public health issue in Taiwan. The delayed diagnosis and treatment of hospitalized patients is considered to be a factor contributing to the nosocomial spread and also creates a threat for health care workers.
We retrospectively analyzed the records of 91 patients diagnosed with active pulmonary tuberculosis after admission, from January 1999 to January 2000. We found the overall median interval between admission and diagnosis (delayed diagnosis) was 3.96±4.09 days; treatment delay was 13.89±4.09 days; and management delay was 14.12±4.22 days. Elderly patients (＞ 65 years old) had a greater chance of a delayed diagnosis (mean 5.31 days vs. 1.61 days). Compared with the pulmonary section, the neurological section had more significantly delayed treatment and management (delayed treatment, 21.05±7.18 days; delayed management, 25.33±7.55 days). But the neurologists were still very alert to pulmonary tuberculosis; their delay in diagnosis (median delayed diagnosis, 4.25±2.21) showed no difference from that of the other sections.
Our results suggest that physicians in Taiwan might not delay in suspecting pulmonary tuberculosis, but that delayed treatment and management does occur. Delayed tuberculosis culture reports might contribute to most delays, even in a medical center with a rapid BACTEC 960 system. More sensitive tuberculosis diagnostic methods and the early isolation of patients suspected of having tuberculosis might be important factors leading to a reduction of the risk to health care workers.

關鍵字

肺結核 ； 延遲性診斷 ； 延遲性治療 ； 延遲性處置

並列摘要

Mycobacterium tuberculosis infection remains an important public health issue in Taiwan. The delayed diagnosis and treatment of hospitalized patients is considered to be a factor contributing to the nosocomial spread and also creates a threat for health care workers.
We retrospectively analyzed the records of 91 patients diagnosed with active pulmonary tuberculosis after admission, from January 1999 to January 2000. We found the overall median interval between admission and diagnosis (delayed diagnosis) was 3.96±4.09 days; treatment delay was 13.89±4.09 days; and management delay was 14.12±4.22 days. Elderly patients (＞ 65 years old) had a greater chance of a delayed diagnosis (mean 5.31 days vs. 1.61 days). Compared with the pulmonary section, the neurological section had more significantly delayed treatment and management (delayed treatment, 21.05±7.18 days; delayed management, 25.33±7.55 days). But the neurologists were still very alert to pulmonary tuberculosis; their delay in diagnosis (median delayed diagnosis, 4.25±2.21) showed no difference from that of the other sections.
Our results suggest that physicians in Taiwan might not delay in suspecting pulmonary tuberculosis, but that delayed treatment and management does occur. Delayed tuberculosis culture reports might contribute to most delays, even in a medical center with a rapid BACTEC 960 system. More sensitive tuberculosis diagnostic methods and the early isolation of patients suspected of having tuberculosis might be important factors leading to a reduction of the risk to health care workers.

並列關鍵字

pulmonary tuberculosis ； delayed diagnosis ； delayed treatment ； delayed management