Tang Peijun, Xu Ping, Shu Wei, Wang Xiafang, Guo Jian, Song Huafeng, Li Sumei, Pang Yu, Wu Meiying
Department of Tuberculosis, The Fifth People's Hospital of Suzhou, Suzhou, China,
National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China,
Infect Drug Resist. 2018 Dec 27;12:87-93. doi: 10.2147/IDR.S181259. eCollection 2019.
We performed a prospective study to investigate the association between pre-diagnosis exposure to fluoroquinolone (FQ) and laboratory testing results among tuberculosis (TB) patients.
Each TB-suspected patient provided sputum specimen for mycobacteria growth indicator tube (MGIT) culture and GeneXpert among pulmonary TB patients. Confirmed TB patients and clinically diagnosed TB patients were further enrolled in the final analysis.
A total of 661 TB patients were included in the final analysis. The distribution of rural TB patients in the FQ-exposed group was significantly higher than that of urban TB patients (=0.02). GeneXpert showed significantly better positive rate than MGIT technology for TB cases with prior FQ exposure (30.6% for GeneXpert vs 20.1% for MGIT, =0.01). The positive rate of GeneXpert was significantly higher than that of MGIT for 7-13 days (=0.04) and ≥14 days FQ exposure (=0.01) groups, respectively. We also found that the positive rate of MGIT was significantly decreased from 31.5% for <7 days levofloxacin (LFX) exposure group to 9.4% for ≥14 days LFX exposure group (=0.01), whereas the positive rate of MGIT displayed significant decrease after 7-13 days exposure to moxifloxacin (=0.04).
In conclusion, our data demonstrate that TB patients prior to sputum collection are prone to yield negative culture results. GeneXpert could bring additional benefits for the detection of pulmonary TB patients with prior exposure to FQs. In addition, the exposure to moxifloxacin affected mycobacterial culture at an earlier stage compared with LFX.
我们进行了一项前瞻性研究，以调查结核病（TB）患者诊断前氟喹诺酮（FQ）暴露与实验室检测结果之间的关联。
每位疑似结核病患者提供痰标本用于分枝杆菌生长指示管（MGIT）培养和肺结核患者的GeneXpert检测。确诊的结核病患者和临床诊断的结核病患者进一步纳入最终分析。
共有661例结核病患者纳入最终分析。FQ暴露组中农村结核病患者的分布显著高于城市结核病患者（P = 0.02）。对于先前暴露于FQ的结核病病例，GeneXpert显示出比MGIT技术显著更高的阳性率（GeneXpert为30.6%，MGIT为20.1%，P = 0.01）。GeneXpert的阳性率在FQ暴露7 - 13天（P = 0.04）和≥14天（P = 0.01）组中分别显著高于MGIT。我们还发现，左氧氟沙星（LFX）暴露<7天组的MGIT阳性率从31.5%显著降至LFX暴露≥14天组的9.4%（P = 0.01），而莫西沙星暴露7 - 13天后MGIT阳性率显著下降（P = 0.04）。
总之，我们的数据表明，痰液采集前的结核病患者容易产生阴性培养结果。GeneXpert对于检测先前暴露于FQ的肺结核患者可能带来额外益处。此外，与LFX相比，莫西沙星暴露在更早阶段影响分枝杆菌培养。
