Schaberg T, Reichert B, Schülin T, Lode H, Mauch H
Section of Infectious Diseases and Immunology, Chest Hospital Heckeshorn-Zehlendorf, Free University of Berlin, Germany.
Eur Respir J. 1995 Oct;8(10):1688-93. doi: 10.1183/09031936.95.08101688.
Radiometric methods for M. tuberculosis drug susceptibility testing yield much faster results than standard techniques; however, these methods require sophisticated equipment and are expensive. We investigated a rapid drug susceptibility testing method for isoniazid, rifampin, ethambutol, streptomycin and pyrazinamide in specimens from 197 patients with pulmonary tuberculosis using a simplified agar-dilution method. Middlebrook 7H11 agar solid medium and microcolony detection were used to test sputum from 64 smear-positive, and from 70 culture-positive but smear-negative patients. Culture-positive material from bronchoscopy, surgical biopsy, pleural fluid or gastric fluid of 63 patients was tested. In 64 smear-positive patients, the median time for final susceptibility results was 11 days (95% confidence interval (95% CI) 10-12 days) compared to 62 days (95% CI 56-66 days) with the standard method. In 133 smear-negative patients, results were available after a median of 35 days (95% CI 32-40 days) in contrast to 72 days (95% CI 62-83 days) with the standard method, regardless of whether or not sputum or other materials were used for primary culture. The rapid method detected all cases of single-drug resistance (n = 20) and multidrug resistance (n = 14) within 13 days (95% CI 9-17 days) in smear-positive patients (n = 8), or within 38 days (95% CI 35-48 days) in smear-negative patients (n = 26). Only one discrepancy was encountered in 985 resistance tests. Moreover, contamination was not observed. Our rapid susceptibility testing method for M. tuberculosis on Middlebrook 7H11 agar is fast, practical and inexpensive. It provides an alternative when more sophisticated techniques are not available or affordable.
用于结核分枝杆菌药敏试验的放射测量方法比标准技术得出结果的速度要快得多；然而，这些方法需要精密的设备且成本高昂。我们使用一种简化的琼脂稀释法，对197例肺结核患者标本中的异烟肼、利福平、乙胺丁醇、链霉素和吡嗪酰胺进行了快速药敏试验研究。采用Middlebrook 7H11琼脂固体培养基和微菌落检测法，对64例涂片阳性患者以及70例培养阳性但涂片阴性患者的痰液进行检测。对63例患者支气管镜检查、手术活检、胸腔积液或胃液的培养阳性材料进行检测。在64例涂片阳性患者中，最终药敏结果的中位时间为11天（95%置信区间[95%CI]10 - 12天），而标准方法为62天（95%CI 56 - 66天）。在133例涂片阴性患者中，无论痰液或其他材料是否用于初次培养，结果在中位时间35天（95%CI 32 - 40天）后可得，而标准方法为72天（95%CI 62 - 83天）。快速方法在涂片阳性患者（n = 8）的13天内（95%CI 9 - 17天）或涂片阴性患者（n = 26）的38天内（95%CI 35 - 48天）检测到所有单耐药（n = 20）和多耐药（n = 14）病例。在985次耐药试验中仅出现1例差异。此外，未观察到污染情况。我们在Middlebrook 7H11琼脂上进行的结核分枝杆菌快速药敏试验方法快速、实用且成本低廉。当无法获得或负担不起更精密的技术时，它提供了一种替代方法。
