H Wallace1, S Crikis1
1Western Health, St Albans, Austral
Aim: Review of outcomes of a targeted screening program for latent tuberculosis infection (LTBI) in a Tertiary Dialysis centre.
Background: The World Health Organisation (WHO) recommends all dialysis patients undertake routine screening for LTBI in high income countries such as Australia. Our unit, however, employs a targeted screening approach in line with the British Thoracic Society guidelines.
Method: A retrospective review of new dialysis patients during the period 2012 – 2018 was undertaken. Patient records were reviewed for basic demographic data, comorbidities, LTBI screening using Quantiferon Gold (QFG), and outcomes, including episodes of active TB, to June 2020.
Results: 472 patients were included. WHO high risk country of origin patients accounted for 22% (n=103). 229 patients (48.5%) were screened using QFG. The main indication for screening was transplantation waitlisting. 34 patients had a positive QFG result. Active tuberculosis developed in two patients during the observation period. Both cases occurred in the screened cohort, and with previous negative QFG results at 11 and 16 months prior to the development of active tuberculosis. No patients in the unscreened cohort developed active tuberculosis during the observation period. WHO high risk country of origin was associated with positive QFG status, odds ratio 10.4 (95% CI 3.3-31.2).
Conclusion: The data failed to show a potential benefit from widening of the current screening program within our unit, however a much larger sample size would be required to show a potential screening benefit. Further analysis of Australian dialysis units is required to ascertain the benefits of widening the screening program across Australia to include all dialysis patients as recommended by the WHO.
Dr Hannah Wallace is in her second year of Renal Advanced Training. She is passionate about medical education and has been involved in presenting intern & resident teaching, as well as volunteering as a tutor for clinical case practice for the Basic Physician Trainees.