Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment

Abstract

Cheng-Yu Chang,1,* Jen-Yee Hong,2,* Mei-Kang Yuan,3,4 Shu-Ju Chang,5 Yuan-Ming Lee,6 Shih-Chieh Chang,2,4 Li-Cho Hsu,2,* Shin-Lung Cheng11Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Internal Medicine, 3Department of Radiology, 4Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 5Department of Industrial Management and Enterprise Information, Aletheia University, Taipei, Taiwan; 6Department of Laboratory Medicine, National Yang-Ming University Hospital, Yilan, Taiwan *These authors contributed equally to this workBackground: Acid-fast bacilli (AFB) smear-positive sputum is usually an initial clue in the diagnosis of pulmonary tuberculosis (TB); however, the test is not disease-specific. Nontuberculous mycobacterium-related colonization or lung disease often has AFB smear-positive sputum results, and physicians may prescribe unnecessary antituberculous drugs for these patients. The aim of this study was to analyze the clinical characteristics of patients with AFB smear-positive sputum who received unnecessary anti-TB treatment.Methods and patients: From January 2008 to July 2011, we retrospectively enrolled 97 patients with AFB smear-positive sputum who did not have pulmonary TB according to mycobacterial cultures and clinical judgment. We analyzed the clinical and radiographic features of the patients who received inappropriate and unnecessary anti-TB treatment. Preliminary analyses of chi-square and Fisher's exact tests were applied to determine factors unlikely to be associated with the independent variables. The relationship between independent covariates was then analyzed using multivariate logistic regression.Results: Of the 97 enrolled patients, 25 (25.8%) were diagnosed with pulmonary TB and prescribed anti-TB drugs (mostly a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide). The other 72 (74.2%) patients were not initially diagnosed with pulmonary TB and were classified as the control group. Compared to the control group, the patients who received inappropriate anti-TB treatment had more chronic cough as presentation symptom and heavy AFB Ziehl–Neelsen staining in sputum (>10/100 fields, grading 2+ to 4+). There were no significant differences in the radiographic analysis between the two groups.Conclusion: Among the patients with AFB smear-positive sputum that did not have pulmonary TB, chronic cough and heavy AFB staining (2+ to 4+) were risk factors for the inappropriate administration of unnecessary anti-TB treatment.Keywords: AFB smear-positive sputum, Mycobacterium tuberculosis, antituberculous treatment