NICE guidelines and the length of inpatient stay for tuberculosis

In response to recently published NICE guidelines on the management of  patients  with  MTB,  we  conducted  a  retrospective  study  of  adult  patients admitted to a large teaching hospital with a confirmed diagnosis of MTB between January 2000 and December 2005.  Fifty-five patients had pulmonary infection, of whom 49 remained in  negative pressure rooms throughout admission and 21 had sputum microscopy positive for acid-fast bacilli.  The mean time taken to return smear results was 26 hours, cultures 36·8 days and susceptibility testing 64·0 days. The mean length of stay for MDR-TB patients was 83·5 days compared with 39·9 days  for  non-MDR-TB  patients.   HIV-positive  patients  did  not  have  prolonged admissions whereas solid organ transplant recipients did (p<0·0001).  The use of automated  liquid  culture  (51%)  and  rpoB  gene  (42%)  and  HIV  testing  (43%)  fell short  of  suggested  standards  yet  this  did  not  affect  length  of  stay.  The  study reflected rising numbers of cases of TB nationally with implications for provision of negative pressure facilities.