Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: A retrospective study in Tianjin, China, 2017-2018

Abstract

Background: Bacteriological confirmation (BC) proportion among notified pulmonary TB patients in China is among the lowest in the world. This study was to understand the yield of BC using different testing strategies and patient-level factors associated with BC among pulmonary TB patients in Tianjin, China during 2017-2018. Methods: A retrospective study was conducted, enrolling pulmonary TB patients reported to National TB Information Management System (TBIMS) in Tianjin during 2017-2018. BC was defined as a positive result by any of the followings: smear microscopy, culture, or nucleic acid amplification test. Individual characteristics were compared between patients with positive and negative bacteriological results using contingency tables and χ2 test. Multivariable logistic regression was applied to analyze factors associated with BC, calculating adjusted odds ratios (aOR) and 95% confidence intervals (CI) (α = 0.05). Results: Of 6364 reported patients, 4181 (65.7%) were bacteriologically confirmed. Positivity proportion was 43.1% (2746/6364) for smear microscopy, 57.7% (3380/5853) for culture, 61.7% (1608/2605) for Xpert® MTB/RIF assay (Xpert) and 73.4% (1824/2484) for combination of the three. The unemployed (aOR = 1.5, 95% CI: 1.0-2.2) and farmers (aOR = 1.7, 95% CI: 1.1-2.8) compared with students; diagnosis by inpatient hospitals compared with TB clinics (aOR = 3.4, 95% CI: 2.6-4.4); having symptoms for ≥2 weeks (aOR = 1.4, 95% CI: 1.1-1.8); cough (aOR = 2.2, 95% CI: 1.8-2.8); blood sputum (aOR = 1.5, 95% CI: 1.0-2.2); cavitation on chest X-ray (aOR = 3.3, 95% CI: 2.5-4.3); bilateral lung lobes affected (aOR = 1.7, 95% CI: 1.4-2.2) were factors associated with BC. Conclusions: Combination test was an effective way to improve BC among pulmonary TB patients. Being unemployed, farmers, having prolonged symptoms, and more severe in TB condition were factors associated with BC. We recommend combination of tests to improve BC for pulmonary TB patients, especially who are in early stage of the disease or with conditions tend to be bacteriologically negative.