Discharge Criteria for TB Bronchiectasis
A patient with TB bronchiectasis can be discharged when they are on effective anti-TB therapy, showing clinical improvement, and have three consecutive negative sputum AFB smears collected on different days. 1
Core Discharge Requirements
The CDC establishes three mandatory criteria that must ALL be met before discontinuing isolation and considering discharge: 1
- Effective anti-TB therapy initiated: Patient must be receiving appropriate multi-drug treatment (typically isoniazid, rifampin, pyrazinamide, and ethambutol initially) 1, 2
- Clinical improvement documented: Reduction in cough, fever resolution, decreased sputum production, and overall symptomatic improvement 1
- Three consecutive negative AFB smears: Sputum samples must be collected on different days (these days may be consecutive) 1
Critical Discharge Planning Components
Before discharge, the following arrangements must be confirmed and in place: 1
- Confirmed outpatient appointment with the provider who will manage the patient until cure is achieved 1
- Sufficient medication supply to bridge until the outpatient appointment 1
- Case management enrollment: Placement into directly observed therapy (DOT) or public health outreach programs 1
- Collaboration with public health authorities to ensure continuation of therapy 1
Special Discharge Considerations
Patients Still Potentially Infectious at Discharge
Patients may be discharged home with positive smears if specific conditions are met: 1
- All household contacts have already been exposed (positive tuberculin skin tests) 1
- No household members are at very high risk for active TB if infected 1
- High-risk contacts include: children less than 4 years of age, HIV-infected persons, or severely immunocompromised individuals 1
- Patient agrees not to have contact with other susceptible persons 1
If high-risk uninfected household members are present, arrangements must be made to prevent their exposure until the patient is confirmed noninfectious. 1
Multidrug-Resistant TB (MDR-TB)
Continued isolation throughout hospitalization should be strongly considered for MDR-TB patients due to the tendency for treatment failure or relapse. 1 These patients require more stringent discharge criteria and should not be de-isolated until culture and susceptibility results confirm appropriate treatment. 3
Monitoring After Discharge
Patients discharged to home must have: 1
- Regular follow-up appointments scheduled 1
- Sputum AFB smears examined regularly (e.g., every 2 weeks) to monitor for relapse 1
- Public health case management to ensure medication adherence 1
Common Pitfalls to Avoid
Do not discharge infectious patients to facilities without isolation capability unless they are returning to their own homes under the conditions described above. 1
Do not assume patients are noninfectious based on clinical improvement alone—the three negative smear requirement is mandatory for hospital discharge without special arrangements. 1
Do not discharge patients without confirmed outpatient follow-up and medication supply, as this leads to treatment interruption and development of drug resistance. 1
The time required for a TB patient to become noninfectious after starting therapy varies considerably, but conversion to negative smear results serves as a practical surrogate for infectiousness even though a small transmission risk may persist until cultures are negative (which takes 6 weeks). 1