结核分枝杆菌抗酸染色 3 次在感染控制目的下的结核筛查中的作用：一个有争议的话题再探讨。
The role of the third acid-fast bacillus smear in tuberculosis screening for infection control purposes: A controversial topic revisited.
机构信息
Department of Medicine, University of British Columbia;
出版信息
Can J Infect Dis Med Microbiol. 2011 Spring;22(1):e1-3. doi: 10.1155/2011/314686.
INTRODUCTION
Recent studies have suggested that two negative acid-fast bacillus (AFB) smears may be as effective as three when screening patients with suspected Mycobacterium tuberculosis for respiratory isolation purposes. However, current recommendations in Canada, the United States and Europe still support a three-smear approach.
METHODS
The microbiology database of a tertiary care hospital was searched for sputum, tracheal aspirates and bronchoalveolar lavage samples from 2003 to 2007 that had been sent for mycobacterial testing. The first patient specimen to become AFB smear positive was noted. As well, the time required to collect the third specimen in hospitalized patients who remained smear negative was used to estimate the savings in isolation costs associated with a two-smear approach.
RESULTS
There were 8347 respiratory specimens from 5168 patients in the five-year period. Of these patients, 2.2% (116 of 5168) were AFB smear positive, of whom 55.2% (64 of 116) were culture positive for Mycobacterium tuberculosis. Overall 89% (57 of 64) of patients were identified as being AFB smear positive by the first smear, 7.8% (five of 64) were identified by the second smear and 3.2% (two of 64) were identified by further smears. Smear-negative patients spent a combined 710 days in isolation awaiting collection of the third sample at a cost of approximately $142,000 over five years.
CONCLUSION
A two-smear approach for discontinuation of respiratory isolation precautions is safe and has the potential to reduce hospital expenditures.
简介
最近的研究表明，在为呼吸道隔离目的筛查疑似结核分枝杆菌患者时，两次阴性抗酸杆菌（AFB）涂片可能与三次一样有效。然而，加拿大、美国和欧洲的现行建议仍支持三次涂片方法。
方法
检索了一家三级保健医院的微生物学数据库，以查找 2003 年至 2007 年间送检分枝杆菌检测的痰、气管抽吸物和支气管肺泡灌洗液样本。记录了第一个成为 AFB 涂片阳性的患者标本。此外，还计算了在连续三次 AFB 涂片均为阴性的住院患者中，收集第三次标本所需的时间，以估算与两次涂片方法相关的隔离费用节省。
结果
在五年期间，共有 5168 名患者的 8347 份呼吸道标本。这些患者中，2.2%（5168 例中的 116 例）为 AFB 涂片阳性，其中 55.2%（116 例中的 64 例）培养出结核分枝杆菌。总体而言，89%（64 例中的 57 例）的患者通过第一次涂片确定为 AFB 涂片阳性，7.8%（64 例中的 5 例）通过第二次涂片确定，3.2%（64 例中的 2 例）通过进一步的涂片确定。连续三次 AFB 涂片均为阴性的患者在等待收集第三次样本期间共隔离 710 天，五年间的费用约为 142000 美元。
结论
停止呼吸道隔离预防措施的两次涂片方法是安全的，并且有可能降低医院支出。
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