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背景:有效的结核病(TB)控制需要对传染性结核病例进行及早诊断,这需要对所有有呼吸系统症状的患者进行早期的肺结核排查。目的:验证我们的假设:在结核病低发病率的欧洲国家,由于对细菌感染的患者优先使用抗生素治疗,导致结核病诊断延迟。设计:在一个独立的城市中心医院,对通过培养确诊的成年肺结核患者进行评价,研究抗生素治疗对症状改善和抗结核治疗起始时间的影响。结果:83例患者中,42例(51%)在诊断结核病之前使用了抗生素,其中20例(48%)患者症状得到改善,这与药物类别无关。虽然接受抗生素治疗的患者诊断周期的中位数延长(P=0.001),但对治疗结果并没有预测性提示。在94%的患者中,最初胸部X线提示有结核感染。结论:结核病诊断前的抗生素治疗,使患者遭受与诊断过程有关的治疗延误。为最大程度降低结核病传播,我们建议临床医生应将结核病包括在最初的鉴别诊断中,在诊断过程初期对有呼吸道症状的患者进行简单的结核病相关检查。
Background: Effective TB control requires an early diagnosis of an infectious TB case, which requires early tuberculosis screening in all patients with respiratory symptoms. PURPOSE: To verify our hypothesis that in European countries with low prevalence of tuberculosis, the diagnosis of tuberculosis is delayed due to the preferential use of antibiotic treatment in patients with bacterial infections. Design: In an independent city center hospital, patients diagnosed with adult pulmonary tuberculosis were evaluated for the effect of antibiotic treatment on symptom improvement and initiation of anti-TB treatment. RESULTS: Of the 83 patients, 42 (51%) used antibiotics prior to diagnosis of tuberculosis and 20 (48%) had improved symptoms, regardless of drug class. Although the median diagnostic cycle was prolonged in patients treated with antibiotics (P = 0.001), there was no predictive prognosis for the treatment outcome. In 94% of patients, the initial chest X-ray suggests tuberculosis infection. Conclusion: Antibiotic treatment prior to TB diagnosis exposes patients to treatment delays associated with the diagnosis. To minimize the spread of tuberculosis, we recommend that clinicians include tuberculosis in their initial differential diagnosis and conduct a simple tuberculosis-related examination of patients with respiratory symptoms early in the diagnosis process.