Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients.

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Abstract
PREVENTING THE spread of tuberculosis (TB) within hospitals is a major concern, particularly since the resurgence of TB in the mid-1980s1-5 and recent reports6-8 of nosocomial outbreaks of multidrug-resistant TB. The current guidelines9 for controlling the transmission of TB within institutions emphasize early identification of patients considered at high risk for the disease. The conventional strategy to deal with this problem is to isolate potentially contagious patients until 2 to 3 smears of sputum are negative for acid-fast bacilli (AFB). The sensitivity of the AFB smear, however, is not high,10-14 and transmission of TB from patients with smears negative for AFB has been reported.15 Delayed recognition and isolation of patients with TB is a well-documented problem. For example, 3 studies16-18 reported that in as many as 50% of the patients with a final diagnosis of TB the risk of the disease was not suspected and the appropriate infection control measures were not instituted on admission to the hospital. Conversely, Scott et al19 reported that in their institution, 92 patients without TB were isolated for every patient with TB, leading to a significant increase in hospital costs.

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