MANAGEMENT AND OUTCOME OF TUBERCULOSIS IN 2 ST-LOUIS HOSPITALS, 1988 TO 1994

OBJECTIVE: To describe management and outcome of tuberculosis (TB) and current practices for isolation in two urban hospitals in the Midwest . DESIGN: Retrospective cohort study. SETTING: Barnes Hospital and Jew ish Hospital, tertiary-care and community hospitals affiliated with Wa shington University School of Medicine in St Louis, Missouri. PATIENTS : All adult patients with a positive culture for Mycobacterium tubercu losis from 1988 to 1994. RESULTS: We identified 122 cases at Barnes an d Jewish Hospitals (36.5/100,000 hospital discharges), median age was 59.0 years, 61.5% were non-Caucasian, and 54.9% resided within the cit y limits. Underlying risk conditions were common: substance abuse (25% ), recent TB contact (24%), and foreign birth (13%). Coexistent human immunodeficiency virus infection (8%) was uncommon. Of skin-tested cas es, 22% were anergic; of the rest, 22% tested negative. Almost 20% of cases had prior positive shin tests, and thus were preventable, but ha d not received adequate prophylaxis. Of hospitalized patients with pul monary TB, 70% received respiratory isolation. Antibiotic resistance w as recognized in 16%; only 19% of cases initially received four-drug t herapy. TB-related death occurred in 16%. CONCLUSIONS: In this area, T B cases primarily involve traditional risk groups without HIV coinfect ion. Current infection control practices, diagnostic strategies, and i nitial treatment regimens are suboptimal. Education about local diseas e epidemiology is needed to prevent nosocomial TB transmission (Infect Control Hosp Epidemiol 1998;19:836-841).