Impact of nucleic acid amplification test on pulmonary tuberculosis notifications and treatments in Taiwan: a 7-year single-center cohort study

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Abstract

Background

Nucleic acid amplification tests (NAAT) have been used as a diagnostic tool for pulmonary tuberculosis (PTB) in Taiwan for many years. In accordance with Taiwanese legislation, health care personnel are required to notify the Centers for Disease Control and Prevention (CDC) in case of suspected PTB. This study aimed to investigate the impact of NAAT(Gen-Probe) on the notification system for PTB and anti-tuberculosis treatments in Taiwan.

Methods

A retrospective study on the impact of NAAT (Enhanced Amplified Mycobacterium tuberculosis Direct Test [E-MTD], Gen-Probe, San Diego, CA, USA) [NAAT(Gen-Probe)] was carried out at Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation from March 2011 to December 2017. During the study period, microscopic acid-fast-bacilli smears and mycobacterial cultures were available for PTB diagnosis. NAAT(Gen-Probe) was first introduced at the hospital in January 2014 for use as a diagnostic method for PTB. Positive sputum culture was considered as the gold standard for PTB diagnosis. We excluded clinically-diagnosed PTB cases.

Results

When NAAT(Gen-Probe) was applied, the rate of error notification to CDC decreased from 64.3 to 7.0% ( P < 0.001), and unnecessary anti-TB treatments administered to suspected cases decreased from 14.9 to 6.5% ( P = 0.005). In the non-PTB group, the mean duration of unnecessary anti-TB treatments changed from 38.9 ± 38.3 days to 37.0 ± 37.9 days ( P = 0.874). In the PTB group, the mean time from notifying CDC to initiating treatment decreased from 3.05 ± 6.95 days to 1.48 ± 1.99 days ( P = 0.004). The sensitivity, specificity, positive predictive value, and negative predictive value of NAAT(Gen-Probe) were 99.0, 92.3, 99.0, and 92.3%, respectively.

Conclusions

Use of NAAT(Gen-Probe) led to decrease in the rate of error notification of suspected PTB cases to the CDC, avoidance of unnecessary use of anti-TB treatments, and accelerated initiation of appropriate treatments.

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Most cited references 19

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Detection and identification of mycobacteria by amplification of rRNA.

T Rogall, T. Flohr, Erik C. Böttger … (1990)

Oligonucleotides specific at a genus, group, or species level were defined by a systematic comparison of small-subunit rRNA sequences from Mycobacterium tuberculosis, M. bovis, M. africanum, M. bovis BCG, M. avium, M. kansasii, M. marinum, M. gastri, M. chelonae, M. smegmatis, M. terrae, M. nonchromogenicum, M. xenopi, M. malmoense, M. szulgai, M. scrofulaceum, M. fortuitum, M. gordonae, M. intracellulare, M. simiae, M. flavescens, M. paratuberculosis, M. sphagni, M. cookii, M. komossense, M. phlei, and M. farcinica. On the basis of the defined oligonucleotides, the polymerase chain reaction technique was explored to develop a sensitive taxon-specific detection system for mycobacteria. By using M. tuberculosis as a model system, fewer than 10 bacteria could be reliably detected by this kind of assay. These results suggest that amplification of rRNA sequences by the polymerase chain reaction may provide a highly sensitive and specific tool for the direct detection of microorganisms without the need for prior cultivation.

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Completeness and timeliness of tuberculosis notification in Taiwan

Hsiu-Yun Lo, Shiang-Lin Yang, Pesus Chou … (2011)

Tuberculosis (TB) is a notifiable disease by the Communicable Disease Control Law in Taiwan. Several measures have been undertaken to improve reporting of TB but the completeness and timeliness of TB notification in Taiwan has not yet been systemically evaluated. Methods To assess completeness and timeliness of TB notification, potential TB cases diagnosed by health care facilities in the year 2005-2007 were identified using the reimbursement database of national health insurance (NHI), which has 99% population coverage in Taiwan. Potential TB patients required notification were defined as those who have TB-related ICD-9 codes (010-018) in the NHI reimbursement database in 2005-2007, who were not diagnosed with TB in previous year, and who have been prescribed with 2 or more types of anti-TB drugs. Each potential TB case was matched to the national TB registry maintained at Taiwan Centers for Disease Control (CDC) by using national identity number or, if non-citizen, passport number to determine whether the patients had been notified to local public health authorities and Taiwan CDC. The difference in the number of days between date of anti-tuberculosis treatment and date of notification was calculated to determine the timeliness of TB reporting. Results Of the 57,405 TB patients who were prescribed with 2 or more anti-tuberculosis drugs, 55,291 (96.3%) were notified to National TB Registry and 2,114 (3.7%) were not. Of the 55,291 notified cases, 45,250 (81.8%) were notified within 7 days of anti-tuberculosis treatment (timely reporting) and 10,041(18.2%) after 7 days (delayed reporting). Factors significantly associated with failure of notification are younger age, previously notified cases, foreigner, those who visited clinics and those who visited health care facilities only once or twice in 6 months. Conclusion A small proportion of TB cases were not notified and a substantial proportion of notified TB cases had delayed reporting, findings with implication for strengthening surveillance of tuberculosis in Taiwan. Countries where the completeness and timeliness of TB notification has not yet been evaluated should take similar action to strengthen surveillance of TB.

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Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

Senedu Bekele Gebreegziabher, Gunnar Aksel Bjune, Solomon Yimer (2016)

Background delay in diagnosis and treatment of tuberculosis (TB) may worsen the disease, increase mortality and enhance transmission in the community. This study aimed at assessing the association between total delay and unfavorable treatment outcome among newly diagnosed pulmonary TB (PTB) patients. Methods A prospective cohort study was conducted in West Gojjam Zone, Amhara Region of Ethiopia from October 2013 to May 2015. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study from 30 randomly selected public health facilities. Total delay (the time period from onset of TB symptoms to first start of anti-TB treatment) was measured. Median total delay was calculated. Mixed effect logistics regression was used to analyze factors associated with unfavorable treatment outcome. Results Seven hundred six patients were enrolled in the study. The median total delay was 60 days. Patients with total delay of > 60 days were more likely to have unfavorable TB treatment outcome than patients with total delay of ≤ 60 days (adjusted odds ratio [AOR], 2.33; 95% confidence interval [CI], 1.04–5.26). Human immunodeficiency virus (HIV) positive TB patients were 8.46 times more likely to experience unfavorable treatment outcome than HIV negative TB patients (AOR, 8.46; 95% CI, 3.14–22.79). Conclusions Long total delay and TB/HIV coinfection were associated with unfavorable treatment outcome. Targeted interventions that can reduce delay in diagnosis and treatment of TB, and early comprehensive management of TB/HIV coinfection are needed to reduce increased risk of unfavorable treatment outcome.

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Author and article information

Contributors

Chih-Wei Wu: isozealot@gmail.com

Yao-Kuang Wu: drbfci@yahoo.com.tw

Chou-Chin Lan: bluescopy@yahoo.com.tw

Mei-Chen Yang: mimimai3461@gmail.com

Ting-Qian Dong: icntb020304@gmail.com

I-Shiang Tzeng: istzeng@gmail.com

Shu-Shien Hsiao: suethion0927@tzuchi.com.tw

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 16 August 2019

Publication date PMC-release: 16 August 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 726

Affiliations

[1 ]ISNI 0000 0004 0572 899X, GRID grid.414692.c, Division of Pulmonary Medicine, , Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, ; New Taipei City, Taiwan

[2 ]ISNI 0000 0004 0572 899X, GRID grid.414692.c, Division of Infection Control, , Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, ; New Taipei City, Taiwan

[3 ]ISNI 0000 0004 0572 899X, GRID grid.414692.c, Division of Research, , Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, ; New Taipei City, Taiwan

[4 ]ISNI 0000 0004 0572 899X, GRID grid.414692.c, Division of Nursing, , Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, ; New Taipei City, Taiwan

Article

Publisher ID: 4358

DOI: 10.1186/s12879-019-4358-8

PMC ID: 6697961

PubMed ID: 31420059

SO-VID: 59923aca-82c4-461e-915e-00b3997c7f11

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 December 2018

Date accepted : 5 August 2019

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: nucleic acid amplification test,treatment initiation,pulmonary tuberculosis,notification,prescription error

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: nucleic acid amplification test, treatment initiation, pulmonary tuberculosis, notification, prescription error

Impact of nucleic acid amplification test on pulmonary tuberculosis notifications and treatments in Taiwan: a 7-year single-center cohort study

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Abstract

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Conclusions

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Point-Of-Care Testing for Tuberculosis

Most cited references 19

Detection and identification of mycobacteria by amplification of rRNA.

Completeness and timeliness of tuberculosis notification in Taiwan

Total Delay Is Associated with Unfavorable Treatment Outcome among Pulmonary Tuberculosis Patients in West Gojjam Zone, Northwest Ethiopia: A Prospective Cohort Study

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