Tuberculosis treatment delay and nosocomial exposure remain important risks for patients undergoing regular hemodialysis

Background and objective: Studies have reported an increased tuberculosis (TB) incidence among patients with end-stage renal disease (ESRD). This nationwide nested Case-control study investigated the risk of active TB due to nosocomial exposure and its correla-tion with the delay in TB treatment in hemodialysis patients.Methods: Adult (aged >20 years) patients with incident ESRD over 2000-2010 were identified from Taiwan National Health Insurance Research Database; 2331 patients with incident active TB (Case) were matched with 11,655 patients without TB (control) by age, sex, year of ESRD onset, Charlson comorbidity index, chronic obstructive pulmonary disease, and diabetes mel-litus, at a 1:5 case-to-control ratio.Results: Compared with the control group, the Case group had greater nosocomial exposure to index patients with pulmonary TB (2.36 vs. 0.11 month of exposure, p < 0.001). Nosocomial exposure increased active TB risk (adjusted odds ratio [OR; 95% confidence interval, CI]: 1.60 [1.55-1.66] per month of exposure), particularly when the exposure time was either within 6 months before the index case was diagnosed or 6-15 months before the ESRD patient became an incident active TB case. For patients with active TB, cough-related medication pre-scriptions (proxy for cough symptoms) exponentially increased over 6 months before TB treat-ment.Conclusion: Nosocomial exposure attributed to delay in the diagnosis of index pulmonary TB is important in TB transmission among patients undergoing regular hemodialysis. Additional studies investigating how TB can be diagnosed and treated early are warranted. Summary at a glance: Our study revealed that nosocomial exposure, attributed to delay in pul-monary TB diagnosis, is important in TB transmission among patients undergoing regular hemo-dialysis. Strategies to diagnose and treat TB early are crucial to infection control, and they warrant further investigations.Copyright 2021, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

The nationwide nested case-control study revealed that nosocomial exposure, attributed to delayed diagnosis of pulmonary TB, plays a significant role in TB transmission among patients undergoing regular hemodialysis. Further investigations into strategies for early TB diagnosis and treatment are warranted.