Abstract
Background: WHO and European guidelines recommend high levels of culture confirmation of pulmonary tuberculosis (TB) cases, and that clinicians report evidence of bacteriological cure. To date these criteria are not used in the UK.
Objectives: 1.To determine why not all cases of notified pulmonary TB have microbiological confirmation, and to identify factors required to improve the proportion of cases confirmed by culture. 2. To investigate the feasibility of obtaining bacteriological cure in culture confirmed cases.
Methods: Records for adults diagnosed with pulmonary TB and notified in 2009 from 3 hospitals in England (Bristol Royal Infirmary, St Mary's and Royal Free) were reviewed. A standard tool collected clinical and demographic data.
Results: 123 cases were identified (85% confirmed HIV negative). 95% of subjects had sputum or lung fluid samples sent for smear and culture. 58% of subjects had smear positive disease. Culture was positive in 79% cases. 5% had no cultures performed - mainly because non-TB specialists requested samples. At treatment completion, 16% of subjects were documented as microbiologically cured and 83%not tested. The main reasons were absence of symptoms and radiological resolution.
Conclusion: To improve bacterial confirmation at diagnosis, current culture techniques need enhancing. An awareness of needing specific mycobacterial samples amongst non-TB specialists may help. Given that documentation of microbiological cure is rarely performed, optimising simple sputum collection may be the only option as it is unlikely that induced sputum or bronchoscopy in asymptomatic patients at treatment end is acceptable, and unlikely to be cost effective.
- © 2011 ERS
