Tuberculosis management practices in Kentucky: Comparison with national guidelines

Background. We assessed the quality of tuberculosis management practices in a predominantly rural state. Methods, Medical records of persons reported to the Centers for Disease Con trol and Prevention (CDC) with the diagnosis of tuberculosis were audited; management practices were compared with guidelines from the American Thorac ic Society (ATS) and CDC. Results, We reviewed 207 records from 24 health districts in Kentucky These records represented 30% of the cases reported to the CDC during the 17-mon th study. Tuberculosis was diagnosed by culture in 66% of patients; 12 diff erent antibiotic regimens for antibiotic sensitive bacteria were prescribed ; human immunodeficiency virus testing was documented in only 39%; monitori ng for drug toxicity and bacteriologic cure was appropriate in <65%; direct ly observed therapy was used in only 38%, and only 23% of close contacts we re reevaluated at 12 weeks. Conclusions, Tuberculosis management practices in Kentucky fall short of AT S/CDC guidelines. Continuing quality-improvement efforts are warranted.