title: Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa.
abstract: BACKGROUND
  Nosocomial transmission of pulmonary tuberculosis (PTB) is a problem in resource-limited settings. However, the degree of TB exposure and the intermediate- and long-term morbidity and mortality of hospital-associated TB is unclear. In this study we determined: 1) the nature, patterns and intensity of TB exposure occurring in the context of current TB cohorting practices in medical centre with a high prevalence of TB and HIV; 2) the one-year TB incidence after discharge; and 3) one-year TB-related mortality after hospital discharge.
  
  
  METHODS
  Factors leading to nosocomial TB exposure were collected daily over a 3-month period. Patients were followed for 1-year after discharge. TB incidence and mortality were calculated and logistic regression was used to determine the factors associated with TB incidence and mortality during follow up.
  
  
  RESULTS
  1,094 patients were admitted to the medical wards between May 01 and July 31, 2010. HIV was confirmed in 690/1,094 (63.1%) of them. A total of 215/1,094 (19.7%) patients were diagnosed with PTB and 178/1,094 (16.3%) patients died during the course of their hospitalization; 12/178 (6.7%) patients died from TB-related complications. Of the 896 (83.7%) discharged patients, 41 (4.6%) [corrected] were diagnosed with TB during the year of follow up. Overall, 123/896 (14%) patients died during the follow up period, of whom 26/123 (21%) died from TB. [corrected] One-year TB incidence rate and TB-associated mortality were associated with the number of days that the patient remained hospitalized, the number of days spent in the cohorting bay (regardless of whether the patient was eventually diagnosed with TB or not), and the number and proximity to TB index cases. There was no difference in the performance of each of these 3 measurements of nosocomial TB exposure for the prediction of one-year TB incidence.
  
  
  CONCLUSIONS
  Substantial TB exposure, particularly among HIV-infected patients, occurs in nosocomial settings despite implementation of cohorting measures. Nosocomial TB exposure is strongly associated with one-year TB incidence and TB-related mortality. Further studies are needed to identify strategies to reduce such exposure among susceptible patients.
authors.affiliation: Division of Infectious Disease, University of Pennsylvania, Philadelphia, Pennsylvania, USA. nzetola@hotmail.com.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Zetola
authors.forename: Nenad
authors.initials: N
authors.lastname: Macesic
authors.forename: Sanghyuk S
authors.initials: SS
authors.lastname: Shin
authors.forename: Sanghyuk
authors.initials: S
authors.lastname: Shin
authors.forename: Alexandra
authors.initials: A
authors.lastname: Peloso
authors.forename: Ronald
authors.initials: R
authors.lastname: Ncube
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Chawangwa
authors.initials: C
authors.lastname: Modongo
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Collman
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000401:mortality*