Background: Despite awareness of HIV-related
tuberculosis (TB), nosocomial outbreaks of multidrug-resistant TB among
HIV-infected individuals occur.
investigate delays in TB isolation and suspicion among HIV-infected
inpatients discharged with TB or Pneumocystis carinii
pneumonia (PCP), common HIV-related pneumonias.
Design: Cohort study during 1995 to 1997.
Setting: For PCP, 1,227 persons who received care at 44 New
York City, Chicago, and Los Angeles hospitals. For TB, 89
patients who received care at five Chicago hospitals.
Measurements: Two-day rates of TB isolation/suspicion.
Results: For HIV-related PCP, Los Angeles hospitals had the
lowest 2-day rates of isolation/suspicion of TB (24.3%/26.6% vs
65.5%/66.4% for New York City and 62.8%/58.3% for Chicago,
respectively; p < 0.001 for overall comparison by χ2
test for each outcome measure). Within cities, hospital
isolation/suspicion rates varied from < 35 to > 70% (p < 0.001
for interhospital comparisons in each city). The Chicago hospital with
a nosocomial outbreak of multidrug-resistant TB from 1994 to 1995
isolated 60% of HIV-infected individuals who were discharged with a
diagnosis of HIV-related TB and 52% discharged with HIV-related PCP,
rates that were among the lowest of all Chicago hospitals in both data
Conclusion: Low 2-day rates of TB
isolation/suspicion among HIV-related PCP patients were frequent. One
Chicago hospital with low 2-day rates of TB isolation/suspicion among
persons with HIV-related PCP also had low 2-day rates of
isolation/suspicion among confirmed TB patients. That hospital
experienced a nosocomial multidrug-resistant TB outbreak. Educational
efforts on the benefits of early TB suspicion/isolation among
HIV-infected pneumonia patients are needed.