与BACTEC 460 TB相比，采用直接分枝杆菌生长指示管和噬菌体扩增生物测定法进行抗分枝杆菌药敏模式的快速表型分析。

Rapid phenotypic assay of antimycobacterial susceptibility pattern by direct mycobacteria growth indicator tube and phage amplified biological assay compared to BACTEC 460 TB.

作者信息

El-Sayed Zaki Maysaa, Goda Tarek

机构信息

Clinical Pathology, Mansoura University, Egypt.

出版信息

Tuberculosis (Edinb). 2007 Mar;87(2):102-8. doi: 10.1016/j.tube.2006.05.002. Epub 2006 Oct 10.

DOI:10.1016/j.tube.2006.05.002

PMID:17035089

Abstract

The performance of antimycobacterial susceptibility testing for the first line drugs (isoniazid, streptomycine, rifampicin and ethambutol) with mycobacteria growth indicator tube (MGIT) and by bacteriophage amplified biological assay by FAST-plaque TB-MDR were compared to automated radiometric BACTEC 460 TB system. This study was carried on 84 sputum samples of positive Zhiel-Neelsen (ZN) smears. Sputum samples were subjected to culture and antimycobacterial susceptibility testing by BACTEC 460 TB. Samples were also tested by direct susceptibility tests for isoniazid (INH), ethambutol, rifampicin (RIF) and streptomycine by MGIT. Sensitive and resistant isolates for RIF were further studied by FAST-plaque TB-MDR for RIF resistance. The commonest resistance pattern by BACTEC 460 TB was for INH (32%) followed by RIF (24%) either alone or in combination with other drugs. Multiple drugs resistance was 20%. The agreement between BACTEC 460 TB and direct MGIT for resistant strains was 100% for INH and ethambutol, 91.7% for rifampicin, 80% for streptomycine and was 90% for MDR. FAST-plaque TB-MDR detected correctly all RIF resistant strains and 97.2% of the sensitive strains. For majority of strains direct susceptibility tests were available within 6.34-6.404 days (95% confidence interval) with direct mycobacteria growth tube, while results for FAST-plaque TB-MDR appear within 10.5-11.5 days from the time that the sputum was received in the laboratory (95% confidence interval). From this study, we could conclude that direct MGIT AST is the quickest method for screening antimycobacterial susceptibility pattern for the drugs commonly used (INH, RIF, etambutol, streptomycin) as results were available within 6.34-6.404 days. Also FAST-plaque TB-MDR method is accurate for detection of rifampicin resistance after primary culture which can be used as a surrogate marker for presence of MDR strains and the results were available within 10.5-11.5 days.

摘要

将采用分枝杆菌生长指示管（MGIT）以及通过FAST - plaque TB - MDR进行噬菌体扩增生物测定法对一线药物（异烟肼、链霉素、利福平及乙胺丁醇）进行的抗分枝杆菌药敏试验的性能，与自动化放射性测量BACTEC 460 TB系统进行了比较。本研究对84份萋尼（ZN）涂片阳性的痰标本开展。痰标本通过BACTEC 460 TB进行培养及抗分枝杆菌药敏试验。标本还通过MGIT对异烟肼（INH）、乙胺丁醇、利福平（RIF）及链霉素进行直接药敏试验。对利福平敏感和耐药菌株通过FAST - plaque TB - MDR进一步研究利福平耐药情况。BACTEC 460 TB最常见的耐药模式是单独或与其他药物联合的异烟肼耐药（32%），其次是利福平耐药（24%）。多重耐药率为20%。对于耐药菌株，BACTEC 460 TB与直接MGIT之间的一致性，异烟肼和乙胺丁醇为100%，利福平为91.7%，链霉素为80%，耐多药为90%。FAST - plaque TB - MDR正确检测出所有利福平耐药菌株及97.2%的敏感菌株。对于大多数菌株，采用直接分枝杆菌生长管进行直接药敏试验在6.34 - 6.404天内（95%置信区间）可获得结果，而FAST - plaque TB - MDR的结果在实验室收到痰标本后的10.5 - 11.5天内出现（95%置信区间）。从本研究中，我们可以得出结论，直接MGIT药敏试验是筛查常用药物（异烟肼、利福平、乙胺丁醇、链霉素）抗分枝杆菌药敏模式的最快方法，因为结果在6.34 - 6.404天内可获得。此外，FAST - plaque TB - MDR方法在初次培养后检测利福平耐药性方面准确，可作为耐多药菌株存在的替代标志物，结果在10.5 - 11.5天内可获得。