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Master Thesis

Tuberculose pulmonaire bacillifère et isolement : état des lieux et apport du contrôle microbiologique

Abstract : Background: Recommendations for isolation of Tuberculous (TB) patients are based on a low level of evidence, which is debated. We have described our isolation practices based on an analysis of microbiological monitoring data.
Methods: We retrospectively analyzed a cohort of patients with bacilliferous tuberculosis hospitalized at the Nice University Hospital between January 2011 and August 2019. The main objective was to describe the isolation practices and the secondary objectives to study the microbiology results and their contribution.
Results: We enrolled 121 bacilliferous inpatients, who were isolated for 25 days (median ± 16.3). Sputum smear controls were frequently performed and were mostly positive (71% and 62% at D14 and D30 respectively), with positive cultures at D14 in 99% and 84% of cases for positive and negative sputum smear respectively (p=0.009), and 96% and 67% of cases at D30 (p=0.02). A negative sputum smear was associated with an "inappropriate" exit (positive culture) in 75% and 67% of cases at D14 and D30 respectively. Having a positive sputum smear or people living in the same household was significantly associated with continued hospitalization. The Time to Detection of BK in liquid culture (TTD) increased significantly between D0, D14 and D30 (medians of 6, 12.5 and 16 days respectively, p < 0.0001), and was inversely correlated with inoculum.
Conclusions: Included patients retained their bacilliferous character for a long time, with BKs that were widely cultivable throughout the first month, despite a negative sputum smear with a low negative predictive value. Yet it was common practice for clinicians to do this before the isolation was lifted, and discharges were often "inappropriate" at that time. However, the risk of contagiousness at discharge was probably limited by a TTD under appropriate treatment that was significantly prolonged, and by clinicians taking into account the patient's environment.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02966719
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Wednesday, October 14, 2020 - 12:28:14 PM
Last modification on : Thursday, April 29, 2021 - 3:13:45 AM

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  • HAL Id : dumas-02966719, version 1

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Constance Blandin. Tuberculose pulmonaire bacillifère et isolement : état des lieux et apport du contrôle microbiologique. Médecine humaine et pathologie. 2020. ⟨dumas-02966719⟩

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