Cohen Gabriel M, Drain Paul K, Noubary Farzad, Cloete Christie, Bassett Ingrid V
*Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; ‡Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA; §Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; ‖The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; ¶Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA; #McCord Hospital, Durban, KwaZulu-Natal, South Africa; and **Center for AIDS Research, Harvard Medical School, Boston, MA.
J Acquir Immune Defic Syndr. 2014 Nov 1;67(3):e88-93. doi: 10.1097/QAI.0000000000000309.
We conducted a retrospective study among HIV-infected adult suspects (≥18 years) with pulmonary tuberculosis (TB), who underwent Xpert MTB/RIF (Xpert) testing at McCord Hospital and its adjoining HIV clinic in Durban, South Africa.
To determine if Xpert testing performed at a centralized laboratory accelerated time to TB diagnosis.
We obtained data on sputum smear microscopy [acid-fast bacilli (AFB)], Xpert, and the rationale for treatment initiation from medical records. The primary outcome was "total diagnostic time," defined as time from sputum collection to clinicians' receipt of results. A linear mixed-effect model compared the duration of steps in the diagnostic pathway across testing modalities.
Among 403 participants, the median "total diagnostic time" for AFB and Xpert was 3.3 and 6.4 days, respectively (P < 0.001). When compared with AFB, the median delay for Xpert "laboratory processing" was 1.4 days (P < 0.001) and "result transfer to clinic" was 1.7 days (P < 0.001). Among 86 Xpert-positive participants who initiated treatment, 49 (57%) started treatment based on clinical suspicion or AFB-positive results, whereas only 32 (37%) started treatment based on Xpert-positive results.
In our setting, Xpert results took twice as long as AFB results to reach clinicians. Replacing AFB with centralized Xpert may delay TB diagnoses in some settings.
我们在南非德班的麦考德医院及其附属的艾滋病诊所，对患有肺结核的成年艾滋病病毒感染疑似患者（≥18岁）进行了一项回顾性研究。
确定在中央实验室进行的Xpert检测是否能加快肺结核诊断时间。
我们从病历中获取了痰涂片显微镜检查[抗酸杆菌（AFB）]、Xpert检测以及开始治疗的理由等数据。主要结局是“总诊断时间”，定义为从痰液采集到临床医生收到结果的时间。线性混合效应模型比较了不同检测方式下诊断途径各步骤的持续时间。
在403名参与者中，AFB和Xpert的“总诊断时间”中位数分别为3.3天和6.4天（P < 0.）。与AFB相比，Xpert“实验室处理”的中位数延迟为1.4天（P < 0.001），“结果传至诊所”的中位数延迟为1.7天（P < 0.001）。在86名开始治疗的Xpert检测呈阳性的参与者中，49名（57%）基于临床怀疑或AFB阳性结果开始治疗，而只有32名（37%）基于Xpert阳性结果开始治疗。
在我们的研究环境中，Xpert结果送达临床医生的时间是AFB结果的两倍。在某些情况下，用中央实验室的Xpert检测取代AFB检测可能会延迟肺结核的诊断。
