Sputum molecular testing may facilitate a more accurate, efficient, and patient-centered assessment for possible tuberculosis (TB) diagnosis, according to a study published in JAMA Internal Medicine.
The study included 621 consecutive adults (≥18 years) hospitalized at Zuckerberg San Francisco General Hospital and Trauma Center between January 2014 and January 2016. These patients had undergone sputum examination for mycobacterium TB and had ≥1 molecular assay. Researchers sought to evaluate the test protocols and patient-centered dynamic of TB testing prior to and after implementation of molecular testing.
In preimplementation, clinicians completed the rapid TB testing evaluation process in 77% of patients (n=233). In postimplementation, 81% of patients had TB evaluation terminated before completion. After introduction of molecular testing, doctors ordered assays for 73% of patients and smear microscopy without assay testing for 27% patients.
Compared with the preimplementation period, the median time to final rapid test result decreased from 39.1 hours to 22.4 hours (P <.001). The median hospital stay for patients declined from 6 days before implementation to 4.9 days after (P =.003). The median duration of respiratory isolation dropped from 2.9 days before implementation to 2.5 days after (P =.001).
The researchers concluded that “[r]outine use of molecular assay testing should be strongly considered to provide faster, more patient-centered care to hospitalized patients undergoing evaluation for TB in the United States and other low TB-burden settings.”
Chaisson LH, Duong D, Cattamanchi A, et al. Association of rapid molecular testing with duration of respiratory isolation for patients with possible tuberculosis in a US hospital [published online August 27, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.3638