Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
BMC Infect Dis. 2010 Mar 6;10:48. doi: 10.1186/1471-2334-10-48.
Little is currently known regarding sputum smear reversion (acid-fast smear becomes positive again after negative conversion) during anti-tuberculous treatment. This study aimed to evaluate its occurrence in patients with pulmonary tuberculosis (TB) and identify factors predicting results of mycobacterial culture for smear-reversion of sputum samples.
The retrospective review was performed in a tertiary referral center and a local teaching hospital in Taiwan. From 2000 to 2007, patients with smear-positive culture-confirmed pulmonary TB experiencing smear reversion after 14 days of anti-tuberculous treatment were identified.
The 739 patients with smear-positive pulmonary TB had 74 (10%) episodes of sputum smear reversion that grew Mycobacterium tuberculosis in 22 (30%) (Mtb group). The remaining 52 episodes of culture-negative sputum samples were classified as the non-Mtb group. The anti-tuberculous regimen was modified after confirming smear reversion in 15 (20%). Fourteen episodes in the Mtb group and 15 in the non-Mtb group occurred during hospitalization. All were admitted to the negative-pressure rooms at the time of smear reversion. Statistical analysis showed that any TB drug resistance, smear reversion within the first two months of treatment or before culture conversion, and the absence of radiographic improvement before smear reversion were associated with the Mtb group. None of the smear reversion was due to viable M. tuberculosis if none of the four factors were present.
Sputum smear reversion develops in 10% of patients with smear-positive pulmonary TB, with 30% due to viable M. tuberculosis bacilli. Isolation and regimen modification may not be necessary for all drug-susceptible patients who already have radiographic improvement and develop smear reversion after two months of treatment or after sputum culture conversion.
目前对于抗结核治疗期间的痰涂片逆转（抗酸染色由阴转阳）知之甚少。本研究旨在评估其在肺结核（TB）患者中的发生情况，并确定预测痰标本分枝杆菌培养涂片逆转结果的因素。
本回顾性研究在台湾的一家三级转诊中心和一家当地教学医院进行。2000 年至 2007 年，确定了 739 例培养阳性、经抗结核治疗 14 天后痰涂片转为阳性的肺结核患者。
739 例痰涂片阳性的肺结核患者中，有 74 例（10%）发生痰涂片逆转，其中 22 例（30%）培养出结核分枝杆菌（Mtb 组）。其余 52 例培养阴性的痰标本被归类为非 Mtb 组。在确认痰涂片逆转后，15 例（20%）修改了抗结核方案。Mtb 组中有 14 例和非 Mtb 组中有 15 例在住院期间发生。在痰涂片逆转时，所有患者均入住负压病房。统计分析表明，任何结核药物耐药、治疗前两个月内或培养转换前发生痰涂片逆转、痰涂片逆转前无影像学改善与 Mtb 组有关。如果不存在这四个因素，则不存在有活力的结核分枝杆菌引起的痰涂片逆转。
10%的痰涂片阳性肺结核患者出现痰涂片逆转，其中 30%是由有活力的结核分枝杆菌引起的。对于已经有影像学改善且在治疗两个月后或痰培养转换后发生痰涂片逆转的所有药敏患者，不一定需要进行隔离和方案调整。
Zotero 插件