Department of Science and Technology-National Research Foundation (DST-NRF) Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Front Cell Infect Microbiol. 2022 Nov 25;12:1065893. doi: 10.3389/fcimb.2022.1065893. eCollection 2022.
Culture remains the gold standard to diagnose spinal tuberculosis (STB) despite the paucibacillary nature of the disease. Current methods can take up to 42 days to yield a result, delaying the ability to rapidly detect drug resistance. Studies have demonstrated the use of supplementation with culture filtrate (CF) from an axenic culture of () as a source of growth factors to improve culture rates. Our objective was to test a modified culture assay, utilizing CF supplemented media (CFSM), to improve culture positivity rates for suspected STB. Twelve patients with suspected STB were assessed by conventional culture (BACTEC™ MGIT 960), GeneXpert™ and standard histopathological examination. Spinal biopsies were taken from areas of diseased vertebral tissue or abscess, predetermined from MRI. Additional biopsies were obtained to assess CFSM for improved detection and faster culture of Mtb. All cases were diagnosed as STB and treated empirically for tuberculosis based on either bacteriological evidence (GeneXpert™, MGIT and/or CFSM positive), or based on clinical presentation. 5 specimens (45.45%) were positive for DNA as detected by GeneXpert™ and 1 specimen (8.33%) was cultured using MGIT (time to detection; 18 days). CFSM was able to culture 7 specimens (58.3%), with all CFSM positive specimens yielding a culture within 14 days. Two samples were positive only using the CFSM assay pointing to additional yield for diagnostic workup. Modification of standard culture can improve detection of and reduce time to positivity in individuals with STB where culture material is a requirement.
尽管脊柱结核 (STB) 的病原菌较少，但培养仍然是诊断 STB 的金标准。目前的方法可能需要长达 42 天才能得出结果，从而延迟了快速检测耐药性的能力。研究已经证明，补充来自（）的无菌培养物的培养液滤出物（CF）作为生长因子的来源可以提高培养率。我们的目的是测试一种改良的培养测定法，利用 CF 补充培养基（CFSM）来提高疑似 STB 的培养阳性率。对 12 例疑似 STB 患者进行了常规培养（BACTEC™MGIT 960）、GeneXpert™和标准组织病理学检查。从 MRI 确定的病变椎骨组织或脓肿区域采集脊柱活检。进行额外的活检以评估 CFSM 以提高 Mtb 的检测和更快的培养。所有病例均诊断为 STB，并根据细菌学证据（GeneXpert™、MGIT 和/或 CFSM 阳性）或临床症状进行经验性抗结核治疗。5 份标本（45.45%）经 GeneXpert™检测到 DNA 阳性，1 份标本（8.33%）通过 MGIT 培养阳性（检测时间；18 天）。CFSM 能够培养 7 份标本（58.3%），所有 CFSM 阳性标本在 14 天内培养出 Mtb。只有两种样本仅使用 CFSM 检测呈阳性，这表明该检测方法具有额外的诊断价值。标准培养的改良可以提高的检测率，并减少 STB 患者培养物要求的阳性时间。
