title: Mycobacterium tuberculosis nucleic acid amplification tests reduce nosocomial tuberculosis exposure in intensive care units: A nationwide cohort study.
abstract: OBJECTIVE
  This retrospective national surveillance study investigated the burden of and risk factors for nosocomial exposure of pulmonary tuberculosis (TB) in intensive care units.
  
  
  METHODS
  Patients admitted to intensive care units were identified from the National Health Insurance Research Database. During 2004-2009, there were 1 387 707 intensive care unit admissions of 900 562 adult patients. Pulmonary tuberculosis association was considered if the patient was diagnosed with pulmonary tuberculosis during admission or within 3 months after discharge. Nosocomial transmissible period was calculated based on the length of anti-tuberculosis treatment and negative-pressure isolation during admission.
  
  
  RESULTS
  Pulmonary tuberculosis was associated with 1.20% of all intensive care unit admissions and 6731 (38.9%) started anti-TB treatment during admission. For the other 10 583 admissions, the diagnosis was made after discharge and anti-TB treatment was not prescribed during admission. The probability paralleled the regional tuberculosis incidence. On average, 2794 pulmonary tuberculosis associated intensive care unit admissions contributed to 42 999-44 062 days of nosocomial exposure per year. The length of nosocomial transmissible period decreased with the gradual implementation of Mycobacterium tuberculosis nucleic acid amplification tests in intensive care practice. Multivariate linear regression analysis revealed that the length of nosocomial transmissible period was inversely associated with male gender, airway symptoms prior to admission and performing M. tuberculosis nucleic acid amplification tests and mycobacterial culture.
  
  
  CONCLUSIONS
  Nosocomial tuberculosis exposure is not uncommon in intensive care units. Performing rapid molecular diagnostic tests in those suspected of tuberculosis is recommended to reduce the risk of nosocomial exposure.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, New Taipei City Hospital, New Taipei, Taiwan.
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Pulmonary Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jer-Hwa
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Pulmonary Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Yu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, New Taipei, Taiwan.
authors.forename: Kuo-Liang
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Department of Nursing, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, New Taipei, Taiwan.
authors.forename: Chiu-Ping
authors.initials: CP
authors.lastname: Su
authors.affiliation: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
authors.forename: Kun-Mao
authors.initials: KM
authors.lastname: Chao
authors.affiliation: Department of Pulmonary Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chih-Hsin
authors.identifier: http://orcid.org/0000-0003-1492-3044
authors.initials: CH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D021141:Nucleic Acid Amplification Techniques; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission
chemical_list: D000995:Antitubercular Agents
keywords: aerosol therapy; cohort study; intensive care; nosocomial infection; pulmonary tuberculosis