Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
Int J Tuberc Lung Dis. 2011 May;15(5):641-6. doi: 10.5588/ijtld.10.0195.
Medical units at an academic tertiary referral hospital in Southern India.
To investigate the impact of solid culture on Löwenstein-Jensen medium on clinical decision making.
In a retrospective review of 150 culture-positive and 150 culture-negative consecutively sampled tuberculosis (TB) suspects, treatment decisions were analysed at presentation, after the availability of culture detection results and after the availability of drug susceptibility testing (DST) culture results.
A total of 124 (82.7%) culture-positive patients and 35 (23.3%) culture-negative patients started anti-tuberculosis treatment prior to receiving their culture results; 101 patients (33.7%) returned for their results; two (1.3%) initiated treatment based on positive culture and no culture-negative patients discontinued treatment. DST was performed on 119 (79.3%) positive cultures: 30 (25.2%) showed any resistance, eight (6.7%) showed multidrug resistance and one (0.84%) showed extensively drug-resistant TB. Twenty-eight patients (23.5%) returned for their DST results. Based on DST, treatment was modified in four patients (3.4%).
Using solid culture, 150 cultures need to be tested for one treatment modification and 30 for DST. The cost of the widespread application of culture will need to be balanced against its impact on treatment decisions in India.
印度南部一所学术性三级转诊医院的医疗单位。
研究固体培养对 Löwenstein-Jensen 培养基对临床决策的影响。
对连续采样的 150 例培养阳性和 150 例培养阴性的结核病（TB）疑似患者进行回顾性研究，分析在出现时、获得培养检测结果后和获得药敏试验（DST）培养结果后的治疗决策。
共有 124 例（82.7%）培养阳性患者和 35 例（23.3%）培养阴性患者在收到培养结果之前开始接受抗结核治疗；101 例患者（33.7%）返回取结果；2 例（1.3%）根据阳性培养开始治疗，无培养阴性患者停止治疗。对 119 例（79.3%）阳性培养物进行了 DST：30 例（25.2%）显示任何耐药性，8 例（6.7%）显示多药耐药性，1 例（0.84%）显示广泛耐药性结核病。28 例患者（23.5%）返回取 DST 结果。根据 DST，4 例患者（3.4%）调整了治疗方案。
使用固体培养，需要检测 150 个培养物以进行一次治疗修改，30 个培养物用于 DST。在印度，广泛应用培养技术的成本需要与它对治疗决策的影响相平衡。
