title: Feasibility of shortening respiratory isolation with a single sputum nucleic acid amplification test.
abstract: BACKGROUND
  Serial smear analysis to guide respiratory isolation (RI) of patients with suspected tuberculosis (TB), the majority of whom will be found not to have TB, leads to expensive and unnecessary isolation, and may potentially result in decreased vigilance of subjects with respiratory compromise.
  
  
  OBJECTIVE
  To compare the performance of a single first-sputum, Mycobacterium tuberculosis-specific nucleic acid amplification (NAA) test with three sputum smears for assessing the need for RI.
  
  
  METHODS
  Prospective evaluation of 493 patients with suspected TB (74% HIV positive) admitted to RI in a major county hospital in the United States, who had at least three sputum smears and material available from the first sample for additional NAA testing.
  
  
  RESULTS
  Accuracy of the first sputum NAA result and serial smears for identifying patients with potentially infectious TB who truly require RI was determined. Forty-six patients (9.3%) had TB confirmed by culture. First-sputum NAA test detected all patients with TB who had a positive smear (n = 35), even when the first of the three specimens was smear negative. In addition, when compared with serial smears, the first-sputum NAA had a higher sensitivity (0.87; 95% confidence interval [CI], 0.74-0.95) and specificity (1.0) in the detection of subjects with positive M. tuberculosis cultures (smear sensitivity, 0.76; 95% CI, 0.61-0.87; and specificity, 0.96; 95% CI, 0.94-0.98).
  
  
  CONCLUSIONS
  A single first-sputum NAA testing can rapidly and accurately identify the subset of patients with suspected TB who require RI according to serial sputum smears. Its potential use to shorten RI time does not preclude the need to obtain subsequent specimens for culture.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, P.O. Box 016960 (R-47), Miami, FL 33101, USA. mcampos1@med.miami.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Campos
authors.forename: Andrew
authors.initials: A
authors.lastname: Quartin
authors.forename: Eliana
authors.initials: E
authors.lastname: Mendes
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abreu
authors.forename: Samuel
authors.initials: S
authors.lastname: Gurevich
authors.forename: Luis
authors.initials: L
authors.lastname: Echarte
authors.forename: Tanira
authors.initials: T
authors.lastname: Ferreira
authors.forename: Timothy
authors.initials: T
authors.lastname: Cleary
authors.forename: Elena
authors.initials: E
authors.lastname: Hollender
authors.forename: David
authors.initials: D
authors.lastname: Ashkin
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis*