INFLUENCE OF HOSPITALIZATION UPON DIAGNOSIS ON THE RISK OF TUBERCULOSIS CLUSTERING

Giuseppe Lapadula, Fabio Zanini, Luigi Codecasa
  • Giuseppe Lapadula
    1Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy)~ , Luigi Sacco Hospital,, Italy | g.lapadula@hsgerardo.org
  • Fabio Zanini
    1Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy)~ , Luigi Sacco Hospital,,
  • Luigi Codecasa
    Affiliation not present

Abstract

Setting: Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999).

Objective: To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clusterization.

Design: Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clusterization.

Results: Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clusterization (OR 1.06, 95%CI 0.75-1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37-0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41-0.76; p<0.001) were running a lower risk of clusterization. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20-2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46-4.25, p=0.001) were significantly more likely to be involved in clusters.

Conclusion: In our cohort, domiciliary treatment was not associated with TB clusterization. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.

Keywords

Tuberculosis, infectivity, cluster analysis, RFLP restriction fragment length polymorphisms, isolation policy

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Submitted: 2014-06-13 09:59:25
Published: 2013-11-19 00:00:00
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