Gasem M H, Dolmans W M, Isbandrio B B, Wahyono H, Keuter M, Djokomoeljanto R
Department of Medicine, Dr. Kariadi Hospital, Diponegoro University, Semarang, Indonesia.
Trop Geogr Med. 1995;47(4):164-7.
We studied the yield of blood and bone marrow (BM) cultures in 145 patients clinically suspected of typhoid fever (TF) in Indonesia. The objectives were to compare the positivity of blood culture using 3 ml versus 10 ml of blood and to examine in how far specific antibiotic treatment for TF interfered with the positivity of BM culture. Blood for culture was collected before antibiotic treatment was initiated in hospital and BM 1 to 10 days after the start of treatment. Cultures were performed with Oxgall subcultured on SS agar. Seventy-nine per cent of patients was treated for 14 days or more with oral chloramphenicol, 18% with chloramphenicol followed by ampicillin or cotrimoxazol and 3% with other antibiotics. Cultures were positive for Salmonella typhi or S-paratyphi A in 57 of the 145 patients (39.3%) when 3 ml of blood was cultured and in 58 (40%) when 10 ml of blood was cultured. BM culture was positive despite antibiotic treatment in 70 patients (48.2%); this positivity was significantly greater than that of blood cultures (p < 0.05). When we considered the positivity of BM culture in relation to the number of days on antibiotics in hospital, the yield of BM culture remained apparently unchanged during the first 5 days of treatment. This may be the consequence of slow elimination of S.typhi or S.paratyphi by the antibiotics used and could be responsible for relapses.
我们对印度尼西亚145例临床疑似伤寒热（TF）患者的血液和骨髓（BM）培养结果进行了研究。目的是比较使用3毫升与10毫升血液进行血培养的阳性率，并研究针对TF的特定抗生素治疗对BM培养阳性率的干扰程度。在医院开始抗生素治疗前采集血培养样本，在治疗开始后1至10天采集BM样本。培养采用接种于SS琼脂上的胆盐培养基。79%的患者接受口服氯霉素治疗14天或更长时间，18%的患者先接受氯霉素治疗，随后使用氨苄西林或复方新诺明，3%的患者使用其他抗生素。当培养3毫升血液时，145例患者中有57例（39.3%）的培养物对伤寒沙门菌或甲型副伤寒沙门菌呈阳性；当培养10毫升血液时，58例（40%）呈阳性。尽管进行了抗生素治疗，70例患者（48.2%）的BM培养仍呈阳性；这种阳性率显著高于血培养（p<0.05）。当我们考虑BM培养阳性率与住院期间使用抗生素天数的关系时，治疗的前5天BM培养的阳性率似乎保持不变。这可能是所用抗生素对伤寒沙门菌或甲型副伤寒沙门菌清除缓慢的结果，并且可能导致复发。
