Tokars J I, Rudnick J R, Kroc K, Manangan L, Pugliese G, Huebner R E, Chan J, Jarvis W R
Hospital Infections Program, National Center for Infectious Diseases, Atlanta, Georgia, USA.
J Clin Microbiol. 1996 Mar;34(3):680-5. doi: 10.1128/jcm.34.3.680-685.1996.
In response to the resurgence of tuberculosis, the Centers for Disease Control and Prevention recommended the use of certain mycobacteriology laboratory methods to improve the accuracy of diagnosis and/or minimize times to complete specimen processing. A study to determine the extent to which these recommended methods were being used in hospital laboratories was needed. In 1992, a survey was mailed to infection control and laboratory personnel at 1,076 hospitals with > or = 100 beds to determine the mycobacterial laboratory services being performed, the methods being used, the number of specimens being processed, and the times to completion during 1991. In 1995, a 20% sample of hospital laboratories that responded to the initial questionnaire was resurveyed. Responses to the 1992 survey were received from personnel at 756 (70%) hospitals representing 750 laboratories. Among laboratories performing the services, the use of recommended methods was as follows: fluorochrome stain for acid-fast bacillus microscopy (47%); radiometric methods for primary culture (29%); rapid (radiometric methods, use of nucleic acid probes, high-performance liquid chromatography, or gas-liquid chromatography) methods for identification of Mycobacterium tuberculosis (59%); and radiometric methods for drug susceptibility testing (55%). Reported times to complete specimen processing were shortest for laboratories that used recommended methods and longest for hospitals that referred specimens to outside laboratories. Only 46% of surveyed laboratories performed at least the minimal number of mycobacterial cultures (20/week) deemed necessary to maintain competence. Among 145 laboratories that performed the services and were resurveyed in 1995, use of recommended techniques increased from 44 to 73% for acid-fast bacillus microscopy, from 27 to 37% for primary culture, from 59 to 88% for M. tuberculosis identification, and from 55 to 75% for drug susceptibility testing. These changes were associated with reductions in reported specimen turnaround times. Use of the methods recommended by the Centers for Disease Control and Prevention increased at the resurveyed hospital mycobacteriology laboratories between 1991 and 1995. However, continued efforts are needed to increase the use of recommended methods at moderate- and high-volume laboratories, encourage referral of specimens from low-volume laboratories, and transmit results rapidly from all laboratories.
为应对结核病的再度流行，疾病控制与预防中心推荐使用某些分枝杆菌学实验室方法，以提高诊断准确性和/或尽量缩短完成标本处理的时间。有必要开展一项研究，以确定医院实验室采用这些推荐方法的程度。1992年，向1076家拥有100张及以上床位的医院的感染控制人员和实验室人员邮寄了一份调查问卷，以确定1991年期间正在开展的分枝杆菌实验室服务、所使用的方法、处理的标本数量以及完成处理的时间。于1995年，对回复初始调查问卷的医院实验室抽取20%进行再次调查。收到了代表750个实验室的756家（70%）医院的人员对1992年调查问卷的回复。在提供这些服务的实验室中，推荐方法的使用情况如下：抗酸杆菌显微镜检查的荧光染色（47%）；初代培养的放射性方法（29%）；结核分枝杆菌鉴定的快速（放射性方法、核酸探针的使用、高效液相色谱法或气-液色谱法）方法（59%）；以及药物敏感性试验的放射性方法（55%）。报告显示，采用推荐方法的实验室完成标本处理的时间最短，而将标本送交外部实验室的医院所需时间最长。在接受调查的实验室中，只有46%至少进行了维持能力所需的最低数量的分枝杆菌培养（每周20次）。在1995年接受再次调查的145家提供这些服务的实验室中，抗酸杆菌显微镜检查的推荐技术使用率从44%提高到73%，初代培养从27%提高到37%，结核分枝杆菌鉴定从59%提高到88%，药物敏感性试验从55%提高到75%。这些变化与报告的标本周转时间缩短相关。1991年至1995年期间，在接受再次调查的医院分枝杆菌学实验室中，疾病控制与预防中心推荐方法的使用有所增加。然而，仍需继续努力，以提高中、高标本量实验室对推荐方法的使用，鼓励低标本量实验室送检标本，并使所有实验室迅速传递结果。
