胸腔内结核的细菌学诊断的采样策略。

Sampling strategy for bacteriological diagnosis of intrathoracic tuberculosis.

机构信息

Laboratoire de bactériologie-hygiène, centre national de référence des mycobactéries et de la résistance des mycobactéries aux antituberculeux, groupe hospitalier, Sorbonne Université, Site Pitié-Salpêtrière, AP-HP, Paris, France; Inserm U1135, Sorbonne université, centre d'immunologie et des maladies infectieuses (CIMI-Paris), Paris, France.

出版信息

Respir Med Res. 2021 May;79:100825. doi: 10.1016/j.resmer.2021.100825. Epub 2021 Apr 27.

DOI:10.1016/j.resmer.2021.100825

PMID:33971432

Abstract

BACKGROUND

Pulmonary tuberculosis (TB) is the most frequent site of TB and the one leading its spread worldwide. Multiple specimens are commonly collected for TB diagnosis including those requiring invasive procedures. This study aimed to review the sampling strategy for the microbiological diagnosis of pulmonary TB.

METHODS

A retrospective analysis of collected samples from September 1st 2014 to May 1st 2016 in the Bacteriology laboratory of Pitié-Salpêtrière Hospital (Paris, France) was performed. All the samples collected in patients aged over 18 years for the bacteriological diagnosis of pulmonary TB were included.

RESULTS

A total of 6267 samples were collected in 2187 patients. One hundred and twenty-six patients (6%) had a culture confirmed pulmonary TB. Among them, multiple sputum collections were sufficient for TB diagnosis in 63.5%, gastric lavages permitted to avoid bronchoscopy in only 7.1%, and bronchoscopy was necessary in 29.4%. The culture positivity of sputa (8.6%) was higher than that of bronchial aspirations (3.1%), bronchiolo-alveolar lavages (BAL) (2.3%) or gastric lavages (4.8%) (P<0.001). From its 70.0% theoretical PPV value, the 46.1% selection in bronchial aspirations allocated to molecular test increased PPV up to 88.9%.

CONCLUSIONS

Based on our data, we suggest to collect sputum consistently. If smear negative a bronchoscopy should be performed and molecular diagnosis be performed on a subset of bronchial aspirations based on expertise of the bronchoscopist.

摘要

背景

肺结核（TB）是最常见的结核病部位，也是全球结核病传播的主要原因。为了诊断结核病，通常需要采集多个标本，包括需要进行有创操作的标本。本研究旨在回顾用于微生物学诊断肺结核的采样策略。

方法

回顾性分析了 2014 年 9 月 1 日至 2016 年 5 月 1 日在法国巴黎皮提耶-萨尔佩特里埃医院细菌学实验室采集的标本。所有收集的 18 岁以上患者的标本均用于细菌学诊断肺结核。

结果

共采集了 2187 例患者的 6267 个样本。126 例患者（6%）的培养结果证实为肺结核。其中，63.5%的患者通过多次采集痰液即可进行结核病诊断，仅 7.1%的患者通过洗胃可避免支气管镜检查，29.4%的患者需要进行支气管镜检查。痰液的培养阳性率（8.6%）高于支气管抽吸物（3.1%）、支气管肺泡灌洗液（BAL）（2.3%）或胃液（4.8%）（P<0.001）。支气管抽吸物的 70.0%理论阳性预测值（PPV），通过支气管镜检查进行选择性检测，将分子检测的 46.1%分配给其结果，可将 PPV 提高到 88.9%。