Cox J N, Brenner E R, Bryan C S
Department of Medicine, University of South Carolina School of Medicine, Columbia.
Infect Control Hosp Epidemiol. 1994 Aug;15(8):513-5. doi: 10.1086/646968.
To evaluate trends in the occurrence and diagnosis of mycobacterial disease.
Prospective surveillance study using a central tuberculosis registry at a 611-bed teaching community hospital.
Data pertaining to 715 patients were entered into the registry between 1976 and 1991 on the basis of positive smears or cultures for acid-fast bacilli (AFB). Over time, the ratio of isolates of Mycobacterium tuberculosis to isolates of nontuberculous mycobacteria reversed (from 3.2 to 1 between 1976 and 1981 to 1 to 1.6 between 1986 and 1991). The sensitivity of the sputum AFB smear for diagnosis of pulmonary tuberculosis increased (from 0.73 to 0.96), but the positive predictive value of the sputum AFB smear declined (from 0.72 to 0.59). The acquired immunodeficiency syndrome epidemic accounted for these changes only to a small extent.
The increasing occurrence of non-tuberculous mycobacterial disease and the declining positive predictive value of the sputum AFB smear at this hospital imply that respiratory isolation and antituberculous therapy will be used inappropriately for many patients. The development and use of newer tests for early isolation and specific identification of M tuberculosis should be accelerated.
评估分枝杆菌病的发生及诊断趋势。
采用前瞻性监测研究，利用一家拥有611张床位的教学社区医院的中央结核病登记处。
1976年至1991年间，基于抗酸杆菌（AFB）涂片或培养阳性，将715例患者的数据录入登记处。随着时间推移，结核分枝杆菌分离株与非结核分枝杆菌分离株的比例发生逆转（从1976年至1981年的3.2比1降至1986年至1991年的1比1.6）。痰AFB涂片诊断肺结核的敏感性增加（从0.73增至0.96），但痰AFB涂片的阳性预测值下降（从0.72降至0.59）。获得性免疫缺陷综合征流行仅在很小程度上导致了这些变化。
该医院非结核分枝杆菌病发生率增加以及痰AFB涂片阳性预测值下降，意味着许多患者将被不恰当地采用呼吸道隔离和抗结核治疗。应加快开发和使用用于早期分离及特异性鉴定结核分枝杆菌的更新检测方法。
