| Pitfalls in the care of patients with tuberculosis. Common errors and their association with the acquisition of drug resistance. | |
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MedLine Citation:
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PMID: 8510299 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine, among a group of patients with multidrug-resistant pulmonary tuberculosis, whether there had been management practices that deviated from established guidelines, and whether these decisions were associated with the acquisition of multidrug resistance and adverse medical sequelae. DESIGN: Case series. SETTING: Referral center. PATIENTS: All patients with pulmonary tuberculosis admitted to the National Jewish Center for Immunology and Respiratory Medicine in 1989 through 1990. INTERVENTIONS: The records of all patients referred to this institution for the treatment of tuberculosis in 1989 through 1990 were reviewed to ascertain the nature of management decisions that might have been associated with the acquisition of drug resistance. MAIN OUTCOME MEASURES: Standards of practice as defined by the American Thoracic Society, the Centers for Disease Control and Prevention, and the American College of Chest Physicians were compared with these management decisions to determine whether "errors" had been made, resulting in treatment failure and the development of acquired drug resistance. RESULTS: Among the 35 study patients, errors were detected in the management decisions in 28; there was an average of 3.93 errors per patient. The most common errors were the addition of a single drug to a failing regimen, failure to identify preexisting or acquired drug resistance, initiation of an inadequate primary regimen, failure to identify and address noncompliance, and inappropriate isoniazid preventive therapy. The multidrug resistance acquired through the errors resulted in prolonged hospitalizations, treatment with more toxic drugs, and high-risk resectional surgery. The costs for this "salvage therapy" were extraordinary, averaging $180,000 per patient. CONCLUSIONS: Aggressive professional education, tighter control on the provisions of care for tuberculosis patients, and the committing of additional resources to tuberculosis control programs are vital in improving the care of tuberculosis patients and limiting the development of acquired drug resistance. |
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Authors:
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A Mahmoudi; M D Iseman |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 270 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 1993 Jul |
Date Detail:
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Created Date: 1993-07-15 Completed Date: 1993-07-15 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 65-8 Citation Subset: AIM; IM |
Affiliation:
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University of Colorado Health Sciences Center, Denver. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Colorado Diagnostic Errors Drug Resistance, Microbial* Female Hospitals, Special / economics, standards*, utilization Humans Length of Stay / economics, statistics & numerical data Male Medical Audit Medication Errors Middle Aged Outcome and Process Assessment (Health Care) Practice Guidelines as Topic Treatment Failure* Tuberculosis, Pulmonary / drug therapy*, economics |
| Grant Support | |
ID/Acronym/Agency:
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HL 07085/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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JAMA. 1994 Jan 12;271(2):103-4; author reply 105
[PMID:
8264061
]
JAMA. 1994 Jan 12;271(2):104-5 [PMID: 8264062 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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