比较 Löwenstein-Jensen 和 BACTEC MGIT 960 培养物在 HIV 感染者中的结核分枝杆菌。

Comparison of Löwenstein-Jensen and BACTEC MGIT 960 culture for Mycobacterium tuberculosis in people living with HIV.

机构信息

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.

出版信息

HIV Med. 2018 Oct;19(9):654-661. doi: 10.1111/hiv.12635. Epub 2018 Jul 3.

DOI:10.1111/hiv.12635

PMID:29971898

Abstract

OBJECTIVES

The aim of the study was to clarify how HIV infection affects tuberculosis liquid and solid culture results in a resource-limited setting.

METHODS

We used baseline data from the Study on Outcomes Related to Tuberculosis and HIV Drug Concentrations in Uganda (SOUTH), which included 268 HIV/tuberculosis (TB)-coinfected individuals. Culture results from Löwenstein-Jensen (LJ) solid culture and mycobacteria growth indicator tube (MGIT) liquid culture systems and culture-based correlates for bacillary density from the sputum of HIV/TB-coinfected individuals at baseline were analysed.

RESULTS

Of 268 participants, 243 had a CD4 cell count available and were included in this analysis; 72.2% of cultures showed growth on solid culture and 82.2% in liquid culture systems (P < 0.015). A higher CD4 cell count was predictive of LJ positivity [adjusted odds ratio (OR) 1.14; 95% confidence interval (CI) 1.03-1.25 per 50 cells/μL increase; P = 0.008]. The same, but insignificant trend was observed for MGIT positivity (adjusted OR 1.09; 95% CI 0.99-1.211 per 50 cells/μL increase; P = 0.094). A higher CD4 cell count was associated with a higher LJ colony-forming unit grade (adjusted OR 1.14; 95% CI 1.05-1.25 per 50 cells/μL increase; P = 0.011) and a shorter time to MGIT positivity [adjusted hazard ratio (HR) 1.08; 95% CI 1.04-1.12 per 50 cells/μL increase; P < 0.001].

CONCLUSIONS

In a resource-limited setting, the MGIT liquid culture system outperformed LJ solid culture in terms of culture yield and dependence on CD4 cell counts in HIV/TB-coinfected individuals. We therefore suggest considering an adaptation of diagnostic algorithms: when resources allow only one culture method to be performed, we recommend that MGIT liquid culture should be used exclusively in HIV-positive individuals as a first-line culture method, to reduce costs and make TB culture results accessible to more patients in resource-limited settings.

摘要

目的

本研究旨在阐明在资源有限的环境下，HIV 感染如何影响结核病液体和固体培养结果。

方法

我们使用了乌干达结核病和 HIV 药物浓度相关研究（SOUTH）的基线数据，该研究包括 268 例 HIV/结核（TB）合并感染个体。分析了 HIV/TB 合并感染者基线时 Löwenstein-Jensen（LJ）固体培养和分枝杆菌生长指示管（MGIT）液体培养系统的培养结果以及基于培养的细菌密度相关指标。

结果

在 268 名参与者中，243 名有 CD4 细胞计数数据，并纳入本分析；72.2%的培养物在固体培养中生长，82.2%在液体培养系统中生长（P<0.015）。较高的 CD4 细胞计数与 LJ 阳性相关[校正优势比（OR）1.14；95%置信区间（CI）每增加 50 个/μL 增加 1.03-1.25；P=0.008]。MGIT 阳性也观察到相同但无统计学意义的趋势（校正 OR 1.09；95%CI 每增加 50 个/μL 增加 0.99-1.211；P=0.094）。较高的 CD4 细胞计数与 LJ 集落形成单位分级较高相关（校正 OR 1.14；95%CI 每增加 50 个/μL 增加 1.05-1.25；P=0.011），MGIT 阳性时间更短[校正风险比（HR）1.08；95%CI 每增加 50 个/μL 增加 1.04-1.12；P<0.001]。

结论

在资源有限的环境下，MGIT 液体培养系统在培养产量和对 HIV/TB 合并感染个体中 CD4 细胞计数的依赖性方面优于 LJ 固体培养。因此，我们建议考虑调整诊断算法：当资源只允许进行一种培养方法时，我们建议在 HIV 阳性个体中仅使用 MGIT 液体培养作为一线培养方法，以降低成本，并使资源有限环境中的更多患者能够获得结核培养结果。