Crowson T W, Rich E C, Woolfrey B F, Connelly D P
JAMA. 1984 Jan 6;251(1):70-2.
Over a five-year period, 1,883 specimens were cultured for mycobacterium tuberculosis (TB) at our hospital. All cultures were negative, and no cases of tuberculous meningitis were diagnosed. Culture rates (percent of CSF specimens cultured for TB) varied from 74% on the Medicine and Neurology services to 6% on the Pediatric service. These culture rates have been stable for five years. These data suggest that on the Medicine and Neurology services, TB cultures of CSF are persistently overutilized. A simple rule of not culturing CSF for TB if results of the CSF analysis are normal (ie, WBC count less than or equal to 4/cu mm, protein level less than or equal to 45 mg/dL, and glucose level greater than or equal to 45 mg/dL) could reduce utilization by at least 50% without adversely affecting quality of care.
在五年期间，我院对1883份标本进行了结核分枝杆菌（TB）培养。所有培养结果均为阴性，未诊断出结核性脑膜炎病例。培养率（脑脊液标本进行TB培养的百分比）在内科和神经科为74%，而在儿科仅为6%。这些培养率在五年间一直保持稳定。这些数据表明，在内科和神经科，脑脊液的TB培养存在持续过度使用的情况。如果脑脊液分析结果正常（即白细胞计数小于或等于4/立方毫米、蛋白水平小于或等于45毫克/分升、葡萄糖水平大于或等于45毫克/分升），则不进行脑脊液TB培养的简单规则可将使用率至少降低50%，且不会对医疗质量产生不利影响。
