Sundaram V, Fujiwara P I, Driver C R, Osahan S S, Munsiff S S
New York City Department of Health, Tuberculosis Control Program, New York 10007, USA.
Int J Tuberc Lung Dis. 2002 Mar;6(3):238-45.
New York City.
To evaluate the yield of continued monthly sputum monitoring after culture conversion.
A retrospective review of tuberculosis patients verified between 1 January 1995 and 31 December 1996 who had: 1) pulmonary tuberculosis with organisms susceptible to isoniazid and rifampin; 2) culture conversion; and 3) completed therapy. We assessed time to smear and culture conversion and number of persons who developed a positive culture after culture conversion (culture reversion).
Of 1440 patients, 379 were cared for by tuberculosis control program providers and 1061 were cared for by other providers; 813 (56%) were initially smear-positive. After the fifth month, 44 (5.3%) were smear-positive; four of these were culture-positive. Eighteen (1.3%) had culture reversions; eight were smear-positive. Excluding one specimen per patient collected at treatment completion, 7967 sputum samples were collected after culture conversion. The minimum estimated cost per culture reversion detected was $26,557.
Continued monthly monitoring of sputum after culture conversion identified a very small number of patients who had culture reversion. However, patients who cannot tolerate or adhere to a standard regimen may need continued monitoring to assess response to treatment. For all patients a specimen should be collected at the end of treatment to document cure.
纽约市。
评估培养转阴后持续每月进行痰监测的产出。
对1995年1月1日至1996年12月31日期间确诊的肺结核患者进行回顾性研究，这些患者具备以下条件：1）患有对异烟肼和利福平敏感的肺结核；2）培养转阴；3）完成治疗。我们评估了涂片和培养转阴的时间以及培养转阴后培养结果转为阳性（培养复阳）的人数。
1440例患者中，379例由结核病控制项目提供者诊治，1061例由其他提供者诊治；813例（56%）最初涂片阳性。第五个月后，44例（5.3%）涂片阳性；其中4例培养阳性。18例（1.3%）出现培养复阳；8例涂片阳性。排除治疗结束时每位患者采集的一份标本，培养转阴后共采集了7967份痰标本。检测到的每例培养复阳的最低估计成本为26,557美元。
培养转阴后持续每月进行痰监测仅发现极少数培养复阳的患者。然而，无法耐受或坚持标准治疗方案的患者可能需要持续监测以评估治疗反应。对于所有患者，应在治疗结束时采集一份标本以证明治愈。
