在被诊断患有结核病的患者中进行潜在结核病的预先查:错过的机会?
Heidi Fischer1, Lei Qian1, Zhuoxin Li1
1Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Open forum infectious diseases
|November 29, 2023
概括
加利福尼亚州大多数结核病 (TB) 患者没有进行潜伏结核病感染 (LTBI) 查. 改善LTBI查实践对于预防结核病进展和减少总体病例至关重要.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 医疗保健管理的管理
背景情况:
- 加利福尼亚州在结核病 (TB) 病例方面领先于美国.
- 这项研究调查了在一个大型的加利福尼亚州卫生系统中,在被诊断患有结核病的患者中,错过了潜伏结核病感染 (LTBI) 查的机会.
研究的目的:
- 评估在随后发展结核病的患者中错过LTBI查机会的程度.
- 评估改善LTBI查对减少结核病发病率的潜在影响.
主要方法:
- 在一个大型南加州卫生系统 (2008-2019) 中,对结核病成年患者 (≥18岁) 的回顾性分析.
- 在结核病诊断之前评估了先前的LTBI测试 (TST或IGRA) 或诊断代码.
- 估计假设的结核病病例通过LTBI治疗来预防.
主要成果:
- 1289名患者确诊结核病;82%的患者没有进行LTBI预查.
- 在患有结核病的患者中,148名患者的LTBI检测呈阳性,84名患者的检测呈阴性.
- 假设的最大预防病例将未查患者的百分比降低到61.7%.
结论:
- 在诊断前,只有五分之一的结核病患者被查LTBI.
- 近62%的结核病病例可能与之前的LTBI查失败有关.
- 需要进一步的研究来识别和解决当前LTBI查指南中的差距.
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