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Free Content Tuberculosis culture testing at a tertiary care hospital: options for improved management and use for treatment decisions

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Abstract:

SETTING: Chris Hani Baragwanath Hospital, a tertiary care hospital in Johannesburg, South Africa.

OBJECTIVES: To determine the proportion of patients with positive Mycobacterium tuberculosis cultures and whether those who were positive were on treatment.

DESIGN: Tuberculosis (TB) culture results were obtained from the laboratory for a 3-month period. Positive results were checked against registrations at the hospital TB Care Centre (TBCC). The treatment status of non-registered patients was obtained from various records at the hospital, district clinics and from home visits.

RESULTS: Overall, 3909 patients had 5404 samples sent for culture. Of these, 708 patients (18%) had at least one positive culture. The positive yield from 2749 adult sputum samples was 33% and ranged from 6% to 40% for different extra-pulmonary specimens. Among 1160 children, the yield varied from 0% to 12%, with 12% in sputum and gastric washing specimens. Of the 708 culture-positive patients, 429 (61%) patients were registered at the TBCC and were known to have started TB treatment. Of the 279 subjects not registered (39% overall), 100 (36%) died. Only 67 of the 179 survivors were confirmed on treatment, 40 were not on treatment and 72 could not be traced.

CONCLUSIONS: Large numbers of TB culture tests were performed, some inappropriately. Study findings highlight inadequacies in the management of culture-confirmed TB at this hospital.

Keywords: culture testing; diagnosis; hospital; registration; tuberculosis

Document Type: Regular Paper

Affiliations: 1: School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; TB Care Centre, Chris Hani Baragwanath Hospital, Soweto, South Africa 2: School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; and TB Care Centre, Chris Hani Baragwanath Hospital, Soweto, South Africa 3: KNCV Tuberculosis Foundation, The Hague, The Netherlands; and Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands 4: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg 5: Division of Pulmonology, University of Witwatersrand, Johannesburg, South Africa; and Chris Hani Baragwanath Hospital, Soweto, South Africa 6: Chris Hani Baragwanath Hospital, Soweto, South Africa; and Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa

Publication date: July 1, 2008

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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