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* From the The Chicago VA Health Care System/Lakeside and Westside Divisions (Dr. Bennett), Loyola University Medical Center (Dr. Parada), the Departments of Preventive Medicine and Internal Medicine of Northwestern University Medical School (Ms. Sipler and Dr. Chmiel), and Cook County Hospital (Drs. Schwartz and Weinstein), Chicago, IL; the West Los Angeles VA (Dr. Goetz), Los Angeles, CA; and the State University of New York Allied Health Program at Brooklyn (Dr. DeHovitz), Brooklyn, NY.
Correspondence to: Charles L. Bennett, MD, PhD, Lakeside VA, 400 East Ontario St, Suite 205, Chicago, IL 60611; e-mail: cbenne{at}nwu.edu
Background: Despite awareness of HIV-related tuberculosis (TB), nosocomial outbreaks of multidrug-resistant TB among HIV-infected individuals occur.
Objective: To investigate delays in TB isolation and suspicion among HIV-infected inpatients discharged with TB or Pneumocystis carinii pneumonia (PCP), common HIV-related pneumonias.
Design: Cohort study during 1995 to 1997.
Setting: For PCP, 1,227 persons who received care at 44 New York City, Chicago, and Los Angeles hospitals. For TB, 89 patients who received care at five Chicago hospitals.
Measurements: Two-day rates of TB isolation/suspicion.
Results: For HIV-related PCP, Los Angeles hospitals had the
lowest 2-day rates of isolation/suspicion of TB (24.3%/26.6% vs
65.5%/66.4% for New York City and 62.8%/58.3% for Chicago,
respectively; p < 0.001 for overall comparison by 
2
test for each outcome measure). Within cities, hospital
isolation/suspicion rates varied from < 35 to > 70% (p < 0.001
for interhospital comparisons in each city). The Chicago hospital with
a nosocomial outbreak of multidrug-resistant TB from 1994 to 1995
isolated 60% of HIV-infected individuals who were discharged with a
diagnosis of HIV-related TB and 52% discharged with HIV-related PCP,
rates that were among the lowest of all Chicago hospitals in both data
sets.
Conclusion: Low 2-day rates of TB isolation/suspicion among HIV-related PCP patients were frequent. One Chicago hospital with low 2-day rates of TB isolation/suspicion among persons with HIV-related PCP also had low 2-day rates of isolation/suspicion among confirmed TB patients. That hospital experienced a nosocomial multidrug-resistant TB outbreak. Educational efforts on the benefits of early TB suspicion/isolation among HIV-infected pneumonia patients are needed.
Key Words: nosocomial outbreak of tuberculosis • patterns of care • quality of care
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