National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Ma-Chang Rd 97, Beijing 101149, China.
Department of Orthopedics, Beijing Bone and Joint Tuberculosis Diagnosis and Treatment Center, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
Int J Infect Dis. 2015 Jul;36:27-30. doi: 10.1016/j.ijid.2015.05.014. Epub 2015 May 21.
Bone and joint tuberculosis (BJTB) constitutes about 10-20% of the extrapulmonary tuberculosis (EPTB) cases in China. The GenoType MTBDRplus assay (MTBDR) has been endorsed by the World Health Organization (WHO) for the diagnosis of pulmonary TB (PTB), while the Xpert MTB/RIF assay (Xpert) has also been endorsed by the WHO for the diagnosis of both PTB and EPTB. The diagnostic utility of these two techniques for BJTB was investigated prospectively.
Sixty pus specimens were obtained from orthopedic patients. Smear, culture, Xpert, and MTBDR assays were performed for each specimen, and MGIT 960-based drug susceptibility testing (DST) was conducted for all of the isolates recovered. The diagnostic efficiency of Xpert and MTBDR was evaluated on the basis of bacteriological examination and the composite reference standard (CRS).
Fifty of the 60 patients were considered to have BJTB according to the CRS. The sensitivities of smear, culture, Xpert, and MTBDR were 26% (13/50), 48% (24/50), 82% (41/50), and 72% (36/50) respectively, while the specificities of all of the tests were 100% (10/10). Xpert was 100% concordant with MGIT 960-based DST for the detection of rifampicin resistance. MTBDR had a sensitivity of 83.3% and a specificity of 100% for the detection of rifampicin resistance and a sensitivity of 85.7% and specificity of 100% for the detection of isoniazid resistance.
With their high sensitivities, short turnaround times, and ability to diagnose TB and detect drug resistance simultaneously, both Xpert and MTBDR are feasible as diagnostic tools for BJTB in clinical practice.
骨关节结核（BJTB）约占中国肺外结核（EPTB）病例的 10-20%。GenoType MTBDRplus 检测（MTBDR）已被世界卫生组织（WHO）认可用于诊断肺结核（PTB），而 Xpert MTB/RIF 检测（Xpert）也被 WHO 认可用于诊断 PTB 和 EPTB。本研究前瞻性研究了这两种技术对 BJTB 的诊断效能。
从骨科患者中获取 60 份脓液标本。对每个标本进行涂片、培养、Xpert 和 MTBDR 检测，并对所有分离株进行基于 MGIT 960 的药敏试验（DST）。根据细菌学检查和综合参考标准（CRS）评估 Xpert 和 MTBDR 的诊断效率。
根据 CRS，60 例患者中有 50 例被认为患有 BJTB。涂片、培养、Xpert 和 MTBDR 的灵敏度分别为 26%（13/50）、48%（24/50）、82%（41/50）和 72%（36/50），而所有检测的特异性均为 100%（10/10）。Xpert 与 MGIT 960 基于 DST 检测利福平耐药的一致性为 100%。MTBDR 检测利福平耐药的灵敏度为 83.3%，特异性为 100%，检测异烟肼耐药的灵敏度为 85.7%，特异性为 100%。
Xpert 和 MTBDR 具有较高的灵敏度、较短的周转时间，并且能够同时诊断结核病和检测耐药性，因此在临床实践中作为 BJTB 的诊断工具是可行的。
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