Tuberculin skin testing of hospitalized patients.
OBJECTIVE
We sought to define the prevalence of tuberculin skin test (TST) positivity in a group of newly hospitalized patients, to identify risk factors for positive tests, and to examine the impact of testing on infection control practices.


METHODS
Unblinded cohort study over 5 days in July 1992.


METHODS
A 1,000-bed university-affiliated hospital.


METHODS
All patients admitted (excluding obstetric patients and newborns) were interviewed. Patients without a history of tuberculosis (TB) or a positive TST were offered a TST with Candida and tetanus controls.


RESULTS
Of 346 patients offered the test, 21 (6%) had a prior history of TB or a positive TST, and 36 (10%) declined to participate; 279 of the remaining 289 completed the study. Anergy was demonstrated in 94 (33.7%) of 279 patients. New positive TSTs were identified in 19 (10.3%) of 185 nonanergic patients. Of the 19 TST-positive patients, 6 (32%) had infiltrates on chest radiographs and were evaluated for active TB. One patient was treated empirically for active TB, and five received isoniazid prophylaxis. Risk factors for a new positive TST included age (odds ratio [OR], 1.56 per decade of life; P = .021), African American race (OR, 4.81; P = .008), alcohol abuse (OR, 5.53; P = .005), and peptic ulcer disease (OR, 4.53; P = .017). Risk factors for anergy included admission to a surgical service (OR, 2.1; P = .006), current use of steroids (OR, 2.65; P = .005), and human immunodeficiency virus (HIV) infection (OR, undefined; P = .034).


CONCLUSIONS
Despite a high rate of anergy, routine tuberculin skin testing identified a substantial number of patients with TB infection who might otherwise have gone unrecognized.
Woeltje
K F
KF
Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
Kilo
C M
CM
Johnson
K
K
Primack
J
J
Fraser
V J
VJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008923:Missouri; D010356:Patient Isolation; D011446:Prospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D014481:United States