Factors associated with sputum culture non-completion and negativity in pulmonary tuberculosis cases in the U.S., 2011–2019 Pubblico
Rautman, Lydia (Spring 2021)
Abstract
Background
Sputum culturing is the gold standard for tuberculosis (TB) disease diagnosis because of its high sensitivity and utility in phenotypic drug sensitivity testing. Around one-quarter of verified TB cases in the United States 2011–2019 had either no sputum culture completed or a negative result, representing opportunities for missed cases and further transmission.
Methods
We used verified TB cases in the National Tuberculosis Surveillance System in bivariate and multivariable models to evaluate the association between predictors and outcomes of 1) sputum culture non-completion and 2) negative sputum culture result.
Results
Odds of sputum culture non-completion were higher among individuals with a non-sputum culture completed, long-term care facility residents, pediatric and elderly patients, and individuals whose care provider was not from a health department. Odds of negative sputum culture were higher among pediatric patients, individuals who had previously had TB, and patients with no cavitation on chest x-rays.
Discussion
In children, high odds of sputum culture non-completion were due to patient inability to expectorate sputum and high odds of negative sputum culture were due to increased rates of paucibacillary disease. In elderly patients and long-term care facility residents, odds of sputum culture non-completion were high due to difficulty obtaining a sputum specimen and incidental diagnosis. Higher suspicion for TB could be the driver behind lower odds of sputum culture non-completion in patients with a non-health department care provider and higher odds of negative sputum culture among patients who had previously had TB. Sputum culture-negative patients seem more likely to present with less cavitation and fewer TB symptoms.
Conclusion
TB sputum culture non-completion is due to patient inability to produce a sample and lack of consideration of TB on the differential diagnosis; a negative result occurs primarily in the presence of paucibacillary TB and in patients with poor immune function. Sputum culture should be performed when possible when considering TB, but non-sputum culture specimens may be available as an alternative. A negative result for any laboratory test should not always rule out TB and clinical evidence should be considered in supporting a diagnosis.
Table of Contents
ACKNOWLEDGEMENTS I
ABSTRACT II
LIST OF FIGURES V
LIST OF TABLES VI
CHAPTER 1: INTRODUCTION 1
Context 1
Key issues 1
Aims, purpose, and significance 2
Definition of terms and concepts 4
CHAPTER 2: LITERATURE REVIEW 5
World and United States epidemiology 5
Pathogenesis 6
Clinical features and treatment 7
Diagnosis 8
Genotyping methods 9
Factors associated with TB infection 10
Pediatric TB 11
Human immunodeficiency virus (HIV) 12
Barriers to diagnosis and treatment 13
Sputum culture non-completion 13
Sputum culture negativity 14
Summary 16
References 17
CHAPTER 3: MANUSCRIPTS 21
Manuscript: Sputum culture non-completion 21
Abstract 22
Introduction 23
Methods 24
Results 25
Discussion 27
Conclusion 31
References 33
Tables and figures 35
Manuscript: Sputum culture negativity 42
Abstract 43
Introduction 44
Methods 45
Results 47
Discussion 49
Conclusion 52
References 54
Tables and figures 56
CHAPTER 4: PUBLIC HEALTH SIGNIFICANCE 63
Summary of research 63
Recommendations and future directions 64
Conclusion 64
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