Bourgi Kassem, Patel Jaimin, Samuel Linoj, Kieca Angela, Johnson Laura, Alangaden George
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Endocrinology, Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
Open Forum Infect Dis. 2017 Mar 10;4(2):ofx045. doi: 10.1093/ofid/ofx045. eCollection 2017 Spring.
Nucleic acid amplification (NAA) testing for (MTB) offers improved diagnostic accuracy, compared with smear microscopy, in differentiating MTB from other mycobacteria. We aimed to evaluate the reliability and projected impact of NAA testing in patients with acid-fast bacilli (AFB) smear-positive respiratory samples.
We identified a retrospective cohort of all patients with AFB smear-positive respiratory specimens at Henry Ford Hospital from January 1, 2001 through December 31, 2011. We examined the association between patients' sociodemographic factors and clinical comorbidities with the likelihood of being diagnosed with MTB. We evaluated the projected change in duration of airborne isolation and unnecessary MTB treatment with introducing NAA testing into clinical decision making for AFB smear-positive patients.
One hundred thirty patients had AFB smear-positive respiratory specimens, 80 of these patients had a positive NAA test result, and 82 patients grew MTB on culture. Nucleic acid amplification testing had a sensitivity and specificity of 97.6% and 100%, respectively. Integrating NAA testing into clinical decision making for patients with AFB-positive smears was associated with a significantly shorter time in airborne isolation (6.0 ± 7.6 vs 23.1 ± 38.0, < .001) and 9.5 ± 11.32 fewer days of unnecessary MTB treatment in patients with negative NAA test.
Nucleic acid amplification testing provided a rapid and accurate test in the diagnosis of MTB while significantly reducing the duration of isolation and unnecessary medications in patients with negative NAA test.
与涂片显微镜检查相比，结核分枝杆菌（MTB）的核酸扩增（NAA）检测在区分MTB与其他分枝杆菌方面具有更高的诊断准确性。我们旨在评估NAA检测在抗酸杆菌（AFB）涂片阳性呼吸道样本患者中的可靠性和预期影响。
我们确定了一个回顾性队列，包括2001年1月1日至2011年12月31日期间在亨利·福特医院所有AFB涂片阳性呼吸道标本的患者。我们研究了患者的社会人口统计学因素和临床合并症与被诊断为MTB可能性之间的关联。我们评估了将NAA检测引入AFB涂片阳性患者的临床决策中，空气传播隔离时间和不必要的MTB治疗的预期变化。
130例患者呼吸道标本AFB涂片阳性，其中80例患者NAA检测结果为阳性，82例患者培养出MTB。核酸扩增检测的敏感性和特异性分别为97.6%和100%。将NAA检测纳入AFB涂片阳性患者的临床决策与空气传播隔离时间显著缩短（6.0±7.6天对23.1±38.0天，P<.001）以及NAA检测阴性患者不必要的MTB治疗天数减少9.5±11.32天相关。
核酸扩增检测在MTB诊断中提供了快速准确的检测，同时显著缩短了NAA检测阴性患者的隔离时间和不必要的用药时间。
