Predicting Mycobacterium tuberculosis in patients with community-acquired pneumonia

The 22 risk factors suggested by the Centers for Disease Control and Prevention (CDC) to suspect patents at risk for Mycobacterium tuberculosis (MTB) have not been evaluated in hospitalized patients with community-acquired pneumonia (CAP). Here, we evaluate which of the CDC risk factors best predict MTB in these patients. To our knowledge, this is the first time a score is developed assessing these risk factors.This was a secondary analysis of 6,976 patients hospitalized with CAP enrolled in the CAPO International Cohort Study. Using Poisson regression, we selected the subset of risk factors that best predicted the presence of CAP due to MTB. This subset was compared to the CDC risk factors using ROC curve analysis.Six risk factors were found to best predict CAP due to MTB: age <65, night sweats, hemoptysis, weight loss, MTB exposure, and upper lobe infiltrate. The area under the ROC curve for all CDC risk factors was 71%, and 89% for the subset of 6 risk factors.The CDC-suggested risk factors are poor at predicting the presence of MTB in hospitalized patients with CAP. With a subset of 6 risk factors identified in this study, we developed a new score, which will improve our capacity to isolate patients at risk of CAP due to MTB at the time of hospitalization.