Microbiological confirmation of tuberculosis cases at diagnosis and at theend of treatment in Italy

Microbiological findings at diagnosis and at the end of treatment are relev ant for evaluating tuberculosis (TB) treatment programmes. The objectives o f this study were to describe the microbiological findings at diagnosis and at the end of treatment in pulmonary and extrapulmonary TB patients treate d under programme conditions in Italy. The study was a prospective monitori ng activity based on the collection of standard recording and reporting for ms from a representative sample of Italian TB Units. The forms with individ ual data were reviewed and analysed on a quarterly basis, 9 months after en rolment. The complete bacteriological profile of patients was analysed at d iagnosis and at the completion of treatment. Individual data on 992 patient s were analysed. At diagnosis 320 (32.2%) of cases were pulmonary sputum sm ear positive, 361 (36.4%) pulmonary smear negative or not done and 311 (33. 4%) extrapulmonary; 424 (42.7%) of all TB cases were culture confirmed at d iagnosis (368, 50.2%, of pulmonary cases); 575 (84.4%) of pulmonary cases h ad a culture done at diagnosis and 156 (22.9%) at the end of treatment (p < 0.001); 572 (84%) had a sputum smear done at diagnosis and 164 (24.1%) at the end of treatment (p < 0.001). Although the rate of bacteriologically co nfirmed cases is similar to that of other European countries, the bacteriol ogical confirmation at diagnosis and, particularly, at the end of treatment , is sub-optimal. The importance of further disseminating national guidelin es among physicians managing TB is emphasized, in order to achieve a higher proportion of TB cases bacteriologically confirmed at diagnosis and monito red at the end of treatment.