Xpert MTB/RIF检测对患有肌肉骨骼感染的儿童肺外结核病的诊断准确性
Diagnostic Accuracy of the Xpert MTB/RIF Assay for Extrapulmonary Tuberculosis in Children With Musculoskeletal Infections.
作者信息
Held Michael, Laubscher Maritz, Mears Stewart, Dix-Peek Stewart, Workman Lesley, Zar Heather, Dunn Robert
机构信息
From the *Orthopedic Research Unit, Department of Orthopedic Surgery, Groote Schuur Hospital, Cape Town, South Africa; †Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
出版信息
Pediatr Infect Dis J. 2016 Nov;35(11):1165-1168. doi: 10.1097/INF.0000000000001271.
BACKGROUND
Xpert MTB/RIF (Xpert) is useful for the diagnosis of extrapulmonary tuberculosis (TB) in adults, but there is limited evidence on its usefulness in children. We aimed to investigate the accuracy of Xpert for the diagnosis of extrapulmonary TB in children with musculoskeletal infections.
METHODS
The diagnostic accuracy of Xpert was compared with a reference standard of culture or histopathology in children hospitalized with suspected osteoarticular TB in Cape Town, South Africa from June 2013 to May 2015.
RESULTS
One hundred and nine samples of 102 patients (60 male; 58.8%) with a median age of 5.6 years (interquartile range: 2.2-8.7) were included. There were 23 samples with confirmed TB by culture or histology (21.1%); histology was positive in all of these, while culture was positive in 14 samples (12.8%). Xpert was positive in 17 samples (15.6%), providing a sensitivity of 73.9% (95% confidence interval: 51.6-89.8) and specificity of 100% (95% confidence interval: 95.7-100). Xpert was positive at a mean of 0.8 days (0.46-1.4) compared with 21 days (19-30) for culture, P < 0.001. Multidrug-resistant TB was detected on culture in a single sample that was negative on Xpert testing.
CONCLUSIONS
Xpert confirmed extrapulmonary TB of bone and joints more accurately and faster than culture and should be used as a first-line test. Histology remains a useful test for musculoskeletal TB in children.
背景
Xpert MTB/RIF（Xpert）在成人肺外结核病（TB）诊断中具有重要作用，但在儿童中的应用证据有限。我们旨在研究Xpert在诊断患有肌肉骨骼感染的儿童肺外结核方面的准确性。
方法
2013年6月至2015年5月期间，在南非开普敦，将Xpert的诊断准确性与疑似骨关节结核住院儿童的培养或组织病理学参考标准进行比较。
结果
纳入了102例患者（60例男性；58.8%）的109份样本，中位年龄为5.6岁（四分位间距：2.2 - 8.7）。通过培养或组织学确诊为结核病的样本有23份（21.1%）；所有这些样本组织学均为阳性，而培养阳性的样本有14份（12.8%）。Xpert检测阳性的样本有17份（15.6%），敏感性为73.9%（95%置信区间：51.6 - 89.8），特异性为100%（95%置信区间：95.7 - 100）。Xpert检测阳性的平均时间为0.8天（0.46 - 1.4），而培养阳性的平均时间为21天（19 - 30），P < 0.001。在一份培养检测出耐多药结核的样本中，Xpert检测为阴性。
结论
Xpert在诊断骨与关节肺外结核方面比培养更准确、更快，应作为一线检测方法。组织学检查对于儿童肌肉骨骼结核仍是一种有用的检测方法。
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