Has the Introduction of Sputum Induction improved the diagnosis of Tuberculosis and decreased the...
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Initial presentation can be with cellulitis, often at the site of minor trauma Aggressive, toxin mediated infections caused by PVL+ MSSA in young, previously well people. Critical care support may be required, and death has occurred following this infection. METHOD n/a RESULTS n/a CONCLUSIONS The HPA has recently issued guidance on ‘‘The diagnosis and management of PVL-associated Staphylococcus aureus (PVL-SA) in England’’. The epidemiology and treatment of PVL-SA infections will be briefly discussed. 0032 HAS THE INTRODUCTION OF SPUTUM INDUCTION IMPROVED THE DIAGNOSIS OF TUBERCULOSIS AND DECREASED THE LENGTH OF HOSPITAL STAY? Kate WOODS, Lucy LAMB, Katherine TAYLOR and Robert DAVIDSON Northwick Park Hospital, London, United Kingdom Background. We previously showed that Sputum Induction (IS) is more sensitive than gastric washings for the diagnosis of pulmonary tuberculosis and this is not enhanced by the use of bronchoalveolar lavage.[1] IS samples are obtained quickly and easily allowing for shorter, less invasive hospital admissions. We wished to evaluate whether routine use of IS (outside of a study situation) improves microbiological diagnosis of tuberculosis, shortens hospital inpatient stay and reduces costs. Methods. We combined clinical and microbiological data from London TB Register (LTBR), hospital databases and case notes to identify all TB patients treated in our unit 6 months prior to and 6 months after introduction of IS sampling at Northwick Park Hospital. Results. After exclusions, we compared 113 TB patients ‘‘pre’’ and 124 patients ‘‘post-IS’’. There was a higher proportion of culture- confirmed cases (62.7% vs. 70.2% [NS]) ‘‘post-IS’’. Introduction of IS led to a reduction in number of patients admitted (p < 0.0001) and length of stay (p < 0.0001), yielding an estimated cost saving of at least £123 per patient. Conclusions. Our routine use of IS for TB diagnosis has led to significantly fewer patients being admitted, a significantly reduced length of stay and reduction in costs. There was improved microbiological diagnosis of TB post introduction of IS but this did not reach statistical significance. [1] Michael Brown, Hansa Varia, Paul Bassett et al. Prospective Study of Sputum Induction, Gastric Washing, and Bronchoalveolar Lavage for the Diagnosis of Pulmonary Tuberculosis in Patients who are unable to expectorate. CID 2007;44: 1415-20. METHOD Patient Population. All TB patients notified at Northwick Park Hospital (NPH) to the LTBR ‘‘pre’’ (1 January 2004 to 1 August 2004) and ‘‘post’’ (1 January 2007 to 1 August 2007) introduction of routine use of induced sputum. Study Design. Retrospective cohort study. Data was collected from LTBR, hospital databases, and case notes. Exclusions. < 16 years old; not under the care of the ID Physicians; initial investigation and treatment started at another Hospital; data unsuitable for analysis. Specimens. TB smear/culture from any specimen taken before, or within 5 days of, starting treatment. Statistical analysis. StatsDirect software. RESULTS Study profile. Patients: 130 ‘‘pre-IS’’, 148 ‘‘post-IS’’. Data analysed, after exclusions, from 113 and 124 patients respectively. Median ages 30 and 34 (p ¼ 0.0456). Predominantly Asian and HIV negative. Culture results. Pulmonary TB (PTB) represented 56.7% ‘‘pre-IS’’ and 42.7% ‘‘post-IS’’ (p < 0.05). Proportion of culture confirmed cases was higher in the ‘‘post-IS’’ group (62.7% vs. 70.2%) but not statistically significant. This was also true for sputa samples of PTB cases (61.2% vs. 65.3%, NS). Length of stay. Less patients admitted ‘‘post-IS’’ (72.6% vs. 37.9%; p < 0.0001) with reduced length of stay (median 2 vs. 0 days; p < 0.0001). Estimated cost saving: £123.41/ patient. CONCLUSIONS The routine introduction of induced sputum (IS) for TB diagnosis at NPH has resulted in significantly less patients being admitted for investigation of TB. The use of IS has also significantly shortened length of stay for TB patients, with a corresponding reduction in costs, conferring benefits not only on the patient but also for the NHS. Our sample was too small to show a significant change in proportion of culture confirmed TB cases, despite sending more sputum samples. Of note, the Mycobacterium TB resistance pattern within our population did not significantly change from 2004 to 2007. 0033 THE MISSING LINK - RECURRENT LYMPH NODE ENLARGEMENT AND ABSCESSES IN AN HIV NEGATIVE FEMALE RECEIVING CHEMOTHERAPY FOR FULLY SENSITIVE MYCOBACTERIUM TUBERCULOSIS Meghan PERRY 1 , Federica FAGGIAN 1 , Clifford LEEN 1 , Rainer DOFFINGER 2 and Dinakantha KUMARARATNE 2 1 Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom, 2 Department of Immunology, Addenbrookes Hospital, Cambridge, United Kingdom S440
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Transcript of Has the Introduction of Sputum Induction improved the diagnosis of Tuberculosis and decreased the...
S440
Initial presentation can be with cellulitis, often at the site of minortraumaAggressive, toxin mediated infections caused by PVL+ MSSA in young,previously well people. Critical care support may be required, anddeath has occurred following this infection.
METHOD
n/a
RESULTS
n/a
CONCLUSIONS
The HPA has recently issued guidance on ‘‘The diagnosis andmanagement of PVL-associated Staphylococcus aureus (PVL-SA) inEngland’’. The epidemiology and treatment of PVL-SA infections willbe briefly discussed.
0032
HAS THE INTRODUCTION OF SPUTUM INDUCTION IMPROVED THE DIAGNOSIS OF TUBERCULOSIS AND DECREASED THELENGTH OF HOSPITAL STAY?Kate WOODS, Lucy LAMB, Katherine TAYLOR and Robert DAVIDSONNorthwick Park Hospital, London, United Kingdom
Background. We previously showed that Sputum Induction (IS) ismore sensitive than gastric washings for the diagnosis of pulmonarytuberculosis and this is not enhanced by the use of bronchoalveolarlavage.[1] IS samples are obtained quickly and easily allowing forshorter, less invasive hospital admissions. We wished to evaluatewhether routine use of IS (outside of a study situation) improvesmicrobiological diagnosis of tuberculosis, shortens hospital inpatientstay and reduces costs.Methods. We combined clinical and microbiological data fromLondon TB Register (LTBR), hospital databases and case notes toidentify all TB patients treated in our unit 6 months prior to and 6months after introduction of IS sampling at Northwick Park Hospital.Results. After exclusions, we compared 113 TB patients ‘‘pre’’ and124 patients ‘‘post-IS’’. There was a higher proportion of culture-confirmed cases (62.7% vs. 70.2% [NS]) ‘‘post-IS’’. Introduction of ISled to a reduction in number of patients admitted (p< 0.0001) andlength of stay (p< 0.0001), yielding an estimated cost saving of atleast £123 per patient.Conclusions. Our routine use of IS for TB diagnosis has led tosignificantly fewer patients being admitted, a significantly reducedlength of stay and reduction in costs. There was improvedmicrobiological diagnosis of TB post introduction of IS but this did notreach statistical significance.[1] Michael Brown, Hansa Varia, Paul Bassett et al. Prospective Studyof Sputum Induction, Gastric Washing, and Bronchoalveolar Lavagefor the Diagnosis of Pulmonary Tuberculosis in Patients who areunable to expectorate. CID 2007;44: 1415-20.
METHOD
Patient Population. All TB patients notified at Northwick ParkHospital (NPH) to the LTBR ‘‘pre’’ (1 January 2004 to 1 August 2004)and ‘‘post’’ (1 January 2007 to 1 August 2007) introduction of routineuse of induced sputum.
Study Design. Retrospective cohort study. Data was collected fromLTBR, hospital databases, and case notes.Exclusions.< 16 years old; not under the care of the ID Physicians;initial investigation and treatment started at another Hospital; dataunsuitable for analysis.Specimens. TB smear/culture from any specimen taken before, orwithin 5 days of, starting treatment.Statistical analysis. StatsDirect software.
RESULTS
Study profile. Patients: 130 ‘‘pre-IS’’, 148 ‘‘post-IS’’. Data analysed,after exclusions, from 113 and 124 patients respectively. Medianages 30 and 34 (p¼ 0.0456). Predominantly Asian and HIV negative.Culture results. Pulmonary TB (PTB) represented 56.7% ‘‘pre-IS’’and 42.7% ‘‘post-IS’’ (p< 0.05). Proportion of culture confirmedcases was higher in the ‘‘post-IS’’ group (62.7% vs. 70.2%) but notstatistically significant. This was also true for sputa samples of PTBcases (61.2% vs. 65.3%, NS).Length of stay. Less patients admitted ‘‘post-IS’’ (72.6% vs. 37.9%;p< 0.0001) with reduced length of stay (median 2 vs. 0 days;p< 0.0001). Estimated cost saving: £123.41/ patient.
CONCLUSIONS
The routine introduction of induced sputum (IS) for TB diagnosis atNPH has resulted in significantly less patients being admitted forinvestigation of TB. The use of IS has also significantly shortenedlength of stay for TB patients, with a corresponding reduction incosts, conferring benefits not only on the patient but also for theNHS. Our sample was too small to show a significant change inproportion of culture confirmed TB cases, despite sending moresputum samples. Of note, the Mycobacterium TB resistance patternwithin our population did not significantly change from 2004 to 2007.
0033
THE MISSING LINK - RECURRENT LYMPH NODE ENLARGEMENT AND ABSCESSES IN AN HIV NEGATIVE FEMALE RECEIVINGCHEMOTHERAPY FOR FULLY SENSITIVE MYCOBACTERIUM TUBERCULOSISMeghan PERRY1, Federica FAGGIAN1, Clifford LEEN1, Rainer DOFFINGER2 and Dinakantha KUMARARATNE2
1Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom, 2Department of Immunology, AddenbrookesHospital, Cambridge, United Kingdom
