title: Impact of early chest radiography and empirical antibiotherapy on delay in the diagnosis of pulmonary tuberculosis.
abstract: OBJECTIVE
  The treatment of community-acquired pneumonia relies on empirical antibacterial treatment, guided by chest X-ray. We evaluated the impact of this practice on delay in the diagnosis of pulmonary tuberculosis.
  
  
  METHODS
  We performed a retrospective monocentric study on 64 documented cases of pulmonary tuberculosis.
  
  
  RESULTS
  Empirical antibacterial treatment was prescribed between the first symptoms and pulmonary tuberculosis diagnosis in 42.2% of cases. The median delay between first contact with a healthcare provider and pulmonary tuberculosis treatment initiation (medical delay) was 13.5 days. The factors associated with medical delay above 30 days were alcohol abuse (OR 7.62; P = 0.02), and late chest X-ray (OR 9.33; P = 0.01). Empirical antibacterial treatment was more frequent in case of late chest X-ray (P = 0.02) and increased the risk of medical delay above 7 days (OR 6.3; P = 0.05).
  
  
  CONCLUSIONS
  When lower respiratory tract infection is suspected, early chest X-ray reduces the empirical use of antibacterial agents and decreases delay in the diagnosis of pulmonary tuberculosis.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, CHU Bichat-Claude-Bernard, 75018 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Gatey
authors.forename: P
authors.initials: P
authors.lastname: Tattevin
authors.forename: C
authors.initials: C
authors.lastname: Rioux
authors.forename: B
authors.initials: B
authors.lastname: Ducot
authors.forename: L
authors.initials: L
authors.lastname: Meyer
authors.forename: E
authors.initials: E
authors.lastname: Bouvet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data; D019468:Disease Management; D042241:Early Diagnosis; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents