title: Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering.
abstract: METHODS
  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 clustering.
  
  
  METHODS
  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 clustering.
  
  
  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 clustering (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 clustering. 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.
  
  
  CONCLUSIONS
  In our cohort, domiciliary treatment was not associated with TB clustering. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.
authors.affiliation: Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lapadula
authors.affiliation: Luigi Sacco Hospital, University of Milan (Italy).
authors.forename: Fabio
authors.initials: F
authors.lastname: Zanini
authors.affiliation: Villa Marelli, AO Cà Granda Niguarda, Milan (Italy).
authors.forename: Luigi
authors.initials: L
authors.lastname: Codecasa
authors.affiliation: Luigi Sacco Hospital, University of Milan (Italy).
authors.forename: Fabio
authors.initials: F
authors.lastname: Franzetti
authors.affiliation: Villa Marelli, AO Cà Granda Niguarda, Milan (Italy).
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrarese
authors.affiliation: Luigi Sacco Hospital, University of Milan (Italy).
authors.forename: Manuela
authors.initials: M
authors.lastname: Carugati
authors.affiliation: Laboratory of Microbiology, AO Cà Granda Niguarda, Milan (Italy).
authors.forename: Ester
authors.initials: E
authors.lastname: Mazzola
authors.affiliation: Luigi Sacco Hospital, University of Milan (Italy).
authors.forename: Consuelo
authors.initials: C
authors.lastname: Schiroli
authors.affiliation: Clinic for Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia (Italy).
authors.forename: Davide
authors.initials: D
authors.lastname: Motta
authors.affiliation: Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy).
authors.forename: Diego
authors.initials: D
authors.lastname: Iemmi
authors.affiliation: Clinic of Infectious Diseases, AO San Gerardo, Monza (Italy).
authors.forename: Andrea
authors.initials: A
authors.lastname: Gori