Usefulness of Mycobacterium tuberculosis-polymerase chain reaction with bronchial washing samples in predicting discontinuation of airborne infection isolation in patients hospitalized with suspected pulmonary tuberculosis

Tae-Ok Kim; Young-Ok Na; Hwa Kyung Park; Jae-Kyeong Lee; Hyung-Joo Oh; Bo Gun Kho; Ha-Young Park; Yong-Soo Kwon; Yu-Il Kim; Sung-Chul Lim; Hong-Joon Shin

doi:10.1371/journal.pone.0279256

Usefulness of Mycobacterium tuberculosis-polymerase chain reaction with bronchial washing samples in predicting discontinuation of airborne infection isolation in patients hospitalized with suspected pulmonary tuberculosis

PLoS One. 2022 Dec 30;17(12):e0279256. doi: 10.1371/journal.pone.0279256. eCollection 2022.

Authors

Tae-Ok Kim^{1

2}, Young-Ok Na¹, Hwa Kyung Park¹, Jae-Kyeong Lee¹, Hyung-Joo Oh¹, Bo Gun Kho¹, Ha-Young Park¹, Yong-Soo Kwon^{1

2}, Yu-Il Kim^{1

2}, Sung-Chul Lim^{1

2}, Hong-Joon Shin^{1

2}

Affiliations

¹ Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
² Chonnam National University Medical School, Gwangju, Republic of Korea.

Abstract

Objective: In-hospital tuberculosis (TB) transmission remains a concern. Airborne infection isolation (AII) can be discontinued in hospitalized patients with suspected active pulmonary TB when the results of three consecutive sputum acid-fast bacilli (AFB) smears are negative. However, fiberoptic bronchoscopy can be performed in patients who may have difficulty in producing sputum samples. This study aimed to investigate the usefulness of Mycobacterium tuberculosis-polymerase chain reaction (MTB-PCR) with bronchial washing specimens in predicting AII discontinuation in hospitalized patients with suspected active pulmonary TB.

Methods: We reviewed the medical charts of patients admitted to a tertiary hospital who were isolated and underwent fiberoptic bronchoscopy for suspicious pulmonary TB from January 2016 to December 2019. Patients with positive MTB-PCR results in the initial sputum examination were excluded. Criteria for discontinuing AII were defined as negative results for three consecutive AFB smears from respiratory specimens, or cases diagnosed other than TB. The study patients were divided into two groups: TB group and non-TB group.

Results: In total, 166 patients were enrolled in the study. Of them, 35 patients were diagnosed with TB. There was no significant difference between the number of males in the TB (81; 61.8%) and non-TB (21; 60.0%) group. Though 139 patients had negative results on MTB-PCR using washing specimens, eight showed positive AFB culture. Of the 139 patients with negative MTB-PCR results, 138 had negative results for three consecutive AFB smears or were established to not have pulmonary TB. Therefore, the predictive accuracy of MTB-PCR with bronchial washing samples for discontinuing AII was 99.2%.

Conclusion: Although a negative result from MTB-PCR with bronchial washing samples cannot exclude pulmonary TB, it can predict AII discontinuation in hospitalized patients with suspected active pulmonary TB.

Copyright: © 2022 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Bronchoalveolar Lavage
Humans
Male
Mycobacterium tuberculosis* / genetics
Polymerase Chain Reaction
Sensitivity and Specificity
Sputum / microbiology
Tertiary Care Centers
Tuberculosis, Pulmonary* / diagnosis
Tuberculosis, Pulmonary* / microbiology

Grants and funding

The authors report the following sources of funding: Grant BCRI20021 from Chonnam National University Hospital Biomedical Research Institute awarded to TOK and Grant 2022R1F1A1069623 from National Research Foundation of Korea funded by the Korean Government awarded to TOK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.