痰标本采集、储存及运输过程对培养结果影响的分析

目的 通过分析某市级结核病实验室痰培养数据,总结县级运送阳性痰标本至市级进行痰培养工作模式对痰培养结果的影响因素。 方法 对江苏省某市级结核病实验室2010年4月-10月痰培养数据进行分析。 结果 该实验室初诊涂阳病人痰培养共计475例,对痰标本采集、储存、运输、培养等各个环节进行分析,得出：不同送样县区（P=0.007）,不同痰标本数量（P=0.008）,不同送样时间间隔（P=0.037）,不同痰标本阳性级别（P=0.001）的痰培养结果均有统计学意义。 结论 由县级运送痰标本至市级进行痰培养,应在采集标本时严格按照《中国结核病防治规划实施工作指南》（以下简称《指南》）要求采集即夜晨3份痰标本,提高送检痰标本质量,尽快送检,并加强对不同县区样品采集运送人员的培训。     

An alternative method for sputum storage and transport for mycobacterium tuberculosis drug resistance surveys.

SETTING: A district level tuberculosis (TB) programme in Indonesia. OBJECTIVE: To evaluate whether a single sputum specimen could be stored by refrigeration for an extended period of time, then transported to a reference laboratory and successfully cultured for Mycobacterium tuberculosis. METHODS: Single sputum specimens were collected from newly diagnosed smear-positive pulmonary TB patients, refrigerated at the study site without addition of 1% cetylpyridinium chloride, batched and sent to the reference laboratory, where they were decontaminated and inoculated into BACTEC MGIT 960 liquid media. RESULTS: One hundred and seven patients were enrolled. The median specimen storage time was 12 days (range 1-38) and median transportation time was 4 days (2-12). The median time from specimen collection until processing was 18 days (4-42). Only 4 (3.7%) specimens failed to grow Mycobacterium species and M. tuberculosis was isolated from 101 (94.4%) specimens. Six specimens with breakthrough contamination successfully grew M. tuberculosis after a second decontamination procedure. CONCLUSIONS: Single sputum specimens collected at a remote setting, refrigerated for relatively long periods without preservatives and transported without refrigeration to a reference laboratory can yield a high positive culture rate. These findings offer potential logistic simplification and cost savings for drug resistance surveys in low-resource countries.     

Impact of sputum gross appearance and volume on smear positivity of pulmonary tuberculosis: a prospective cohort study

ABSTRACT: BACKGROUND: Although checking specimen quality upon sputum collection for acid-fast smear of suspected tuberculosis (TB) cases is recommended, this procedure is based on expert opinion. The purpose of this study was to elucidate the impact of sputum gross appearance and volume on smear positivity among patients with suspected pulmonary TB, according to sex. METHODS: From November 2010 through June 2011, we enrolled consecutive patients suspected to have active pulmonary TB. The association of sputum gross appearance and volume with smear positivity, along with other variables possibly affecting smear positivity such as symptoms, disease extent, and cavity on chest radiograph, were investigated. RESULTS: Among 2,439 patients undergoing TB examination, 170 (113 men, 57 women) with active pulmonary TB were enrolled in the final analysis. They submitted 492 sputa. There were 73 smear-positive patients (42.9%) and 164 smear-positive sputa (33.3%). While gross appearance was associated with smear positivity in both sexes (purulent or blood-tinged sputum (rather than mucoid sputum or saliva); odds ratio (OR), 2.05, 95% confidence interval (CI), 1.21-3.47 in men; OR, 2.78, 95% CI, 1.23-6.26 in women), the amount of sputum specimens was associated with smear positivity in only female patients (4 ml or more versus less than 4 ml; OR, 4.96, 95% CI, 1.98-12.37). CONCLUSIONS: Sputum gross appearance and volume were associated with smear positivity. A volume of 4 ml seems to be the the minimum sputum volume acceptable for smear microscopy in females suspected of TB. Those suspected of TB should be encouraged to expectorate grossly qualified sputum specimens.     

A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting.

SETTING: Nairobi City Council Chest Clinic, Kenya. OBJECTIVES: To establish the efficiency, costs and cost-effectiveness of six diagnostic strategies using Ziehl-Neelsen (ZN) and fluorescence microscopy (FM). DESIGN: A cross-sectional study of 1398 TB suspects attending a specialised chest clinic in Nairobi subjected to three sputum examinations by ZN and FM. Lowenstein-Jensen culture was used as the gold standard. Cost analysis included health service and patient costs. RESULTS: Of 1398 suspects enrolled, 993 (71%) had a complete diagnostic work-up involving three sputum specimens for ZN and FM, culture and chest X-ray (CXR). Irrespective of whether ZN or FM was used on one, two or three smears, the overall diagnostic process detected 92% culture-positive cases. Different strategies affected the ratio of smear-positive to smear-negative TB; however, FM was more sensitive than ZN (P < 0.001). FM performance was not affected by the patient's HIV status. The cost per correctly diagnosed smear-positive case, including savings, was 40.30 US dollars for FM on two specimens compared to 57.70 US dollars for ZN on three specimens. CONCLUSION: The FM method used on one or two specimens is more cost-effective and shortens the diagnostic process. Consequently, more patients can be put on a regimen for smear-positive TB, contributing to improved treatment and reducing transmission.     

Characteristics, management and outcome of patients with recurrent tuberculosis under routine programme conditions in Malawi.

SETTING: All 43 non-private hospitals in Malawi, which registered TB cases between 1 July 1999 and 30 June 2000. OBJECTIVES: To determine 1) the characteristics, management and treatment outcome, 2) timing of the previous episode of TB, and 3) pattern of drug resistance in patients registered with recurrent smear-positive pulmonary TB. DESIGN: Retrospective data collection using TB registers and laboratory culture and drug sensitivity registers. RESULTS: There were 748 recurrent patients; data were available for 747. Of these, 487 (65%) successfully completed a re-treatment regimen, 185 (25%) died and the remainder had another outcome. Information about previous TB was recorded for 491 (66%) patients. In 286 (58%) there were 2 years or less between completing and re-starting treatment. Only 307 (41%) patients had sputum sent for culture and drug sensitivity tests. In 164 patients with cultures of Mycobacterium tuberculosis, 122 (81%) were fully sensitive, 25 (15%) had resistance to isoniazid and/or streptomycin, and 6 (4%) had resistance to isoniazid and rifampicin (MDR-TB). CONCLUSION: Patients with recurrent TB had acceptable treatment outcomes, and most had fully sensitive organisms. Over half had recurrent TB 2 years or less after completing treatment. Ways to prevent recurrence need to be investigated and implemented in the field.     

Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis.

OBJECTIVES: To assess the yield of repeated sputum induction for the diagnosis of active tuberculosis in patients who do not produce spontaneous sputum, or with smear-negative spontaneous samples. METHODS: Induced sputum was examined with fluorescent microscopy, two amplification methods (PCR Amplicor MTB, and MTD2), and cultured for mycobacteria using liquid (Bactec 12B) and Lowenstein-Jensen media. Bronchoscopy and collection of other specimens were performed at the discretion of the treating physician. RESULTS: A total of 1115 sputum inductions performed in 500 patients without adverse events yielded an adequate specimen in 1113 (99.8%), and microbiological confirmation in 43 of 44 (98%) culture-positive active TB cases. Yield increased with repeated sputum induction. The cumulative yield for acid-fast bacilli smear and mycobacterial culture was 64% and 70% respectively for one, 81% and 91% for two, 91% and 99% for three, and 98% and 100% for four induced samples. Yield of PCR also increased with the greater number of induced samples tested. CONCLUSIONS: Repeated sputum induction could considerably improve diagnostic accuracy for pulmonary TB.     

Quality assessment of sputum transportation, smear preparation and AFB microscopy in a rural district in Malawi.

SETTING: Ntcheu District, Central Region of Malawi. OBJECTIVES: To assess 1) the feasibility of introducing simple internal quality control procedures for acid-fast bacilli (AFB) microscopy, and 2) the quality of the district sputum smear microscopy service. DESIGN: A simple internal quality control system was piloted in which district laboratory staff assessed: 1) specimen suitability, 2) time between sputum submission and smear examination, 3) smear preparation and staining, and 4) microscopy. Actual times for processing specimens were compared with recommended times. External quality validation was carried out. RESULTS: Of 4805 sputum specimens: 1) documentation was complete in 95%, 2) 93% reached the laboratory within 7 days of collection, 3) 96% of smears were well prepared and stained, and 4) 97% concordance (96.4% smear-positive and 97.6% smear-negative) was demonstrated when 208 smears were re-examined by a second technician. The aggregate index of reliability was 86%. The mean time spent on microscopic examination was 3.8 minutes, compared with the recommended time of 10 minutes. When all smears from 164 patients were assessed externally, 98.2% concordance (98.1% smear-positive and 98.2% smear-negative) was demonstrated. False smear-negative and smear-positive rates were less than 2% each. CONCLUSION: District laboratory staff were able to incorporate simple quality control procedures for AFB microscopy into their routine practice, resulting in a reliable service. The lessons learnt are widely relevant and potentially useful for implementation of a national quality assurance scheme.     

Is it valuable to examine more than one sputum smear per patient for the diagnosis of pulmonary tuberculosis?

The simplest, cheapest, and fastest diagnostic method for tuberculosis (TB) is the detection of acid-fast bacilli (AFB) by microscopy. The algorithm advised for the diagnosis of TB recommends examination of three consecutive sputum specimens from TB suspects for the presence of AFB. In the present study, we evaluated the contribution of each specimen to the final detection of TB suspect patients with culture-proven disease. The collection and analysis of retrospective data on patients with culture-proven pulmonary TB, from June 2002 to August 2006 at Dokuz Eylul University Hospital, Turkey, have enabled us to assess the value of examining two sputum specimens in diagnosing this disease. AFB were detected from one or more sputum specimens with direct microscopy in 42% of the cases. An analysis of results of smear examination showed that 97% of AFB were detected from the first specimen and only 3% were obtained from the second smear. The third specimen did not have any additional diagnostic value for the detection of AFB by microscopy. As a conclusion the present study shows that examining two sputum smears is sufficient for the early detection of AFB in our laboratory.     

不同痰标本处理方法对结核分枝杆菌罗氏培养检测结果的影响

目的 分析采用简单法和离心法处理痰标本,以及采用离心法处理痰标本时不同离心条件对罗氏培养检测结果的影响。方法 收集2010年9-11月北京市结核病胸部肿瘤研究所国家结核病临床实验室进行细菌学检查的疑似结核病患者痰标本198份,其中涂片阳性的痰标本99份,涂片阴性的痰标本99份。同时应用简单法和离心法对198份痰标本进行罗氏培养;离心法培养时分别采用5种不同的离心条件：3000×g离心15 min、3000×g离心8 min、3000×g离心25 min、2000×g离心15 min、5000×g离心15 min。结果 任何一种方法培养阳性即认定标本培养阳性,198份痰标本中共有126份培养阳性,其中97份来自涂阳痰标本,29份来自涂阴痰标本;简单法的阳性率为93.65%（118/126）,离心法最高的阳性率为96.03%（121/126）。简单法的平均初生长时间为（20±8.56） d,离心法（3000×g离心15 min）的平均初生长时间为（22±9.10）d,两者间差异有统计学意义（Z=-4.81, P<0.001）。在125份离心法培养阳性的标本中,3000×g离心15 min、3000×g离心8 min、3000×g离心25 min、2000×g离心15 min、5000×g离心15 min,5种不同离心条件下的培养阳性率分别为96.03%（121/126）、89.68%（113/126）、95.24%（120/126）、92.06%（116/126）和96.03%（121/126）。 结论 罗氏培养过程中,简单法的阳性率与离心法接近,但由于简单法操作简单、污染率较低,初生长时间较短,因而可能更符合临床的需要;应用离心法进行罗氏培养时,离心力或离心时间的变化可能会影响培养的阳性率。     

发光二极管荧光显微镜检测结核分枝杆菌在基层实验室的应用评价

目的 评价发光二极管（light-emitting diodes,LED）荧光显微镜在基层实验室痰涂片中检测结核分枝杆菌的应用效果。 方法 收集2011年7月至2011年9月在青海省西宁市7个县（区）级结核病防治机构（简称“结防机构”）就诊的所有肺结核可疑症状者592例（1738份痰标本）。对每份痰标本涂片2张,分别进行萋-尼（Ziehl-Neelsen, Z-N）抗酸染色和金胺O（auramine O）荧光染色,然后以盲法用传统光学显微镜和LED荧光显微镜进行检测,以简单法固体罗氏培养（L-J）结果为金标准,比较两种显微镜阳性检出率的差异、诊断的准确性及检出时间的差异。 结果 LED荧光显微镜痰涂片阳性检出率为14.90%（259/1738）,比传统光学显微镜13.75%（239/1738）提高1.15%,差异有统计学意义（Z=5.88,P〈0.05）。以简单法固体罗氏培养结果为金标准,传统光学显微镜的敏感度为79.60%（199/250;95%CI=74.60％～84.60%）,特异度为97.31%（1446/1486;95%CI=96.49％～98.13%）;ROC曲线下面积为0.8878（95%CI=0.8623～0.9133）。LED荧光显微镜的敏感度为84.80%（212/250;95%CI=80.30%～89.25%）,特异度为96.84%（1439/1486;95%CI=95.95%～97.73%）,ROC曲线下面积为0.9118（95%CI=0.8890～0.9347）。传统光学显微镜的平均读片时间为（185.600±79.271）s,LED荧光显微镜的平均读片时间为（144.19±62.173）s,时间差异有统计学意义（t=15.32, P〈0.01）。 结论 应用LED荧光显微镜可明显提高痰涂片中结核分枝杆菌的阳性检出率,较传统光学显微镜有更高的敏感度,但特异度相当,诊断肺结核患者的价值更高,且能明显缩短读片时间。     

Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections

STUDY OBJECTIVE: To determine the utility of bronchoscopy with bronchoalveolar lavage for diagnosing M tuberculosis and fungal infections. DESIGN: Retrospective review of patients over a six-year period. SETTING: In- and outpatients of one University hospital and affiliated Veterans Administration Medical Center. PATIENTS: Those who were subsequently found to have either M tuberculosis or fungal infections. INTERVENTIONS: Bronchoscopy with bronchoalveolar lavage specimens were compared to prebronchoscopy sputum, when available. Specimens were sent for smear and culture for both acid-fast bacilli and fungi. In the case of lavage, an aliquot also was studied for cellular differential. MEASUREMENTS AND RESULTS: For TB, sputum was smear-positive in 6/47 (34 percent) and culture positive in 24/47 (51 percent), while bronchoscopy was smear positive in 34/50 (68 percent) and culture positive in 46/50 (92 percent). For fungal infections, no sputum was smear-positive and only 1/22 (5 percent) was sputum culture-positive, while bronchoscopy was smear-positive in 14/41 (34 percent) and culture positive in 35/41 (85 percent). Bronchoscopy washings and BAL provided complementary specimens. Eighty-three patients had adequate lavages and the cellularity was significantly different from controls (lymphocytes: TB 18 +/- 11.2 percent [mean +/- SD]; fungal: 13 +/- 11.1 percent; controls 6 +/- 3.1 percent; p less than 0.001; neutrophils: TB 9 +/- 11.5 percent; fungal: 6 +/- 9.1 percent controls: 2 +/- 1.5 percent, p less than 0.01); however, there was overlap and no pattern was characteristic for TB or fungal infections. CONCLUSION: Bronchoscopy with BAL is useful in diagnosing tuberculosis and fungal infections.     

Yield of continued monthly sputum evaluation among tuberculosis patients after culture conversion.

SETTING: New York City. OBJECTIVE: To evaluate the yield of continued monthly sputum monitoring after culture conversion. DESIGN: A retrospective review of tuberculosis patients verified between 1 January 1995 and 31 December 1996 who had: 1) pulmonary tuberculosis with organisms susceptible to isoniazid and rifampin; 2) culture conversion; and 3) completed therapy. We assessed time to smear and culture conversion and number of persons who developed a positive culture after culture conversion (culture reversion). RESULTS: Of 1440 patients, 379 were cared for by tuberculosis control program providers and 1061 were cared for by other providers; 813 (56%) were initially smear-positive. After the fifth month, 44 (5.3%) were smear-positive; four of these were culture-positive. Eighteen (1.3%) had culture reversions; eight were smear-positive. Excluding one specimen per patient collected at treatment completion, 7967 sputum samples were collected after culture conversion. The minimum estimated cost per culture reversion detected was $26,557. CONCLUSION: Continued monthly monitoring of sputum after culture conversion identified a very small number of patients who had culture reversion. However, patients who cannot tolerate or adhere to a standard regimen may need continued monitoring to assess response to treatment. For all patients a specimen should be collected at the end of treatment to document cure.     

Diagnostic yield of repeated smear microscopy examinations among patients suspected of pulmonary TB in Shandong province of China.

OBJECTIVES: To analyse the yield of five repeated smear microscopy examinations for the diagnosis of smear-positive pulmonary tuberculosis (TB). METHODS: Patients with respiratory symptoms and abnormal chest X-rays provided five spontaneous sputum samples for acid-fast bacilli (AFB) smear microscopy in one of nine county laboratories. RESULTS: Of 9302 patients with respiratory symptoms and abnormal X-rays, 6437 (69%) had at least one smear-positive sputum. Of these, 84.5% were diagnosed on the first smear, 96.7% on the first two smears, and 99.9% on the first three sputum smears. The fourth and fifth sputum smears yielded only seven additional cases (0.1%). CONCLUSIONS: Smear microscopy examination of two spontaneous sputum specimens is the most efficient, and three sputum smear examinations provide a diagnosis in almost all cases.     

Evaluation of a unified treatment regimen for all new cases of tuberculosis using guardian-based supervision.

SETTING: Ntcheu District, Malawi, using an oral antituberculosis treatment regimen. OBJECTIVE: To determine whether directly observed treatment (DOT) during the initial phase of treatment supervised either in hospital, at health centres or by guardians in the community, was associated with 1) satisfactory 2-month and 8-month treatment outcomes, and 2) with a reduction of in-patient hospital-bed days. DESIGN: Prospective data collection of all tuberculosis (TB) patients registered between 1 April 1996 and 30 June 1997, with 2-month and 8-month treatment outcomes, sputum smear conversion in smear-positive pulmonary TB patients (PTB) and in-patient hospital-bed days. RESULTS: Among the 600 new patients, 302 had smear-positive PTB, 150 smear-negative PTB and 148 extrapulmonary TB (EPTB). Eight-month treatment completion was 65% for smear-positive PTB patients, which was significantly higher than in patients with smear-negative PTB (45%) and EPTB (54%), due mainly to high 8-month mortality rates. The site of the intensive phase was determined in 596 patients: 178 (30%) received DOT from guardians, 115 (19%) from a health centre and 303 (51%) in hospital. At 2 months, mortality rates were significantly higher in hospitalised patients. Two-month treatment outcomes (including sputum smear conversion rates in smear-positive PTB patients) were similar between patients receiving DOT at health centres or from guardians. Decentralised DOT resulted in a 25% reduction in hospital-bed days in patients alive at 2 months compared with that predicted using the old regimens. CONCLUSION: Decentralising DOT to health centres and to guardians during the intensive phase is associated with satisfactory treatment outcomes.     

Screening tuberculosis suspects using two sputum smears.

SETTING: Ntcheu district hospital, Malawi. OBJECTIVE: To assess a screening strategy for tuberculosis (TB) suspects using two sputum smears. DESIGN: A strategy of screening all TB suspects with two sputum smears for 6 months (1 July-31 December 1998) was compared with the period 1 January to 30 June 1998 during which the strategy of screening TB suspects with three sputum smears was in use. All chest radiographs of patients with negative sputum smears were assessed, and in those with pulmonary cavities and extensive disease a third sputum smear was examined. Data were collected from the laboratory sputum register and the TB register. The two 6-month periods were compared. RESULTS: In the laboratory register, using a two-sputum strategy, 186 (16%) of 1152 TB suspects were smear-positive, a result that was no different than when the three-sputum strategy was used, where 173 (16%) of 1106 TB suspects were smear-positive. The clinical pattern of TB using the different screening strategies was similar, with 58% of registered patients smear-positive with the two-sputum strategy and 54% smear-positive with the three-sputum strategy. In the first 6 months 3177 sputum smears were examined compared to 2266 smears in the second 6 months, a 29% reduction in the number of smears examined. The cost of consumables using the strategy of three sputum smears was USD $731 compared with USD $521 using the strategy of two sputum smears. C O N C L U S I O N S: Screening TB suspects using two sputum smears is as effective as screening using three sputum smears, and is associated with less laboratory work and savings in costs.     

Evaluation of the Idaho Technology LightCycler PCR for the direct detection of Mycobacterium tuberculosis in respiratory specimens.

SETTING: The rapid detection of Mycobacterium tuberculosis (TB) in clinical samples is an important goal. The LightCycler heralds an advance in thermal cycle technology combining rapid cycle DNA amplification with fluorimetry, eliminating the need to perform amplification and product analysis separately. OBJECTIVES: To evaluate the LightCycler for direct detection of M. tuberculosis complex in respiratory specimens. To evaluate a DNA extraction method based on Chelex 100 resin, heating and ultrasonication for the prevention of endogenous inhibitions in respiratory samples. DESIGN: DNA was extracted from sputum samples using the Chelex method and polymerase chain reaction (PCR) for TB performed with the LightCycler. RESULTS: For 88 sputum samples positive by microscopy and culture for M. tuberculosis, 95% were PCR-positive. None of the five sputum samples that were smear-negative but culture-positive for M. tuberculosis, the 79 culture-negative sputum samples and the 29 sputum samples that were culture-positive for mycobacteria other than TB yielded positive PCR results. PCR inhibitors were not detected in any of the samples. CONCLUSION: The LightCycler proved a simple, reproducible and rapid system, reducing the time to result from weeks (culture) or days (conventional PCR) to hours. The Chelex 100 resin method produced good results for the smear-positive specimens. However, a larger study is required to determine the efficacy of the method with smear-negative specimens and for specimens known to contain endogenous inhibitors.     

Economic evaluation of the use of PCR assay in diagnosing pulmonary TB in a low-incidence area.

To determine whether polymerase chain reaction (PCR) testing in the initial diagnosis of pulmonary tuberculosis (TB) is cost-effective in a low-prevalence population, an economic evaluation was carried out between the smear and culture (NOPCR) and smear, culture and PCR (+PCR) strategies. A decision tree model based on retrospective laboratory data was developed to assess the strategies of testing patients with suspicion of TB. Direct healthcare costs prior to confirmation of TB or nontuberculous mycobacteria by PCR or culture were included. Effectiveness was measured by the probability of correct treatment and isolation decisions. In the baseline situation NOPCR costs Euro 29.50 less than the +PCR strategy per patient tested. According to sensitivity analyses, reducing PCR test price, shortening test performance time or increasing the proportion of smear-positive patients in the tested population would contribute to cost savings with the +PCR strategy. Routine polymerase chain reaction testing of all specimens from suspected tuberculosis patients in a low-prevalence population was not cost-saving. When the polymerase chain reaction assay was applied only to smear-positive sputum specimens, the smear and culture strategy was clearly dominated by it, i.e. the polymerase chain reaction smear-positive sputum strategy was less costly and more effective in producing correct treatment decisions and isolations.     

Recovery rate of NTM from AFB smear-positive sputum specimens at a medical centre in South Korea.

OBJECTIVE: To investigate the recovery rate of non-tuberculous mycobacteria (NTM) from acid-fast bacilli (AFB) smear-positive sputum specimens at a tertiary care medical centre in South Korea with a high pulmonary tuberculosis (PTB) burden. DESIGN: Retrospective analysis of data from AFB smear- and culture-positive sputum specimens collected between January 1998 and December 2001. RESULTS: Over 4 years, 1328 sputum specimens collected from 616 patients were AFB smear- and culture-positive. NTM were recovered from 9.1% (121/1328) of the smear-positive sputum specimens, and from 8.1% (50/616) of patients with smear-positive sputum. NTM were isolated at least twice in 94% (47/50) of the patients from whom NTM was recovered. The most common organism found was Mycobacterium avium complex, followed by M. abscessus. CONCLUSION: These results suggest that a substantial proportion of patients at a tertiary care medical centre in South Korea with AFB smear-positive sputum specimens may have NTM lung disease rather than PTB.     

Predictors of sputum culture conversion among patients with tuberculosis in the era of tuberculosis resurgence.

BACKGROUND: Sputum culture conversion among patients with tuberculosis (TB) is the most important indicator for the effectiveness of treatment and the infectivity of the disease. We sought to investigate predictors for documented sputum culture conversion among TB cases reported in the surveillance system. METHODS: This study included 780 patients with pulmonary TB who were initially sputum culture positive in New Jersey in 1994-1995. These patients were followed up for at least 1 week and up to 1 year. Kaplan-Meier curves and Cox proportional hazards models were performed to analyze the data. RESULTS: Overall, 469 (60.1%) of the 780 patients had documented sputum culture conversion. The elderly (36%) and non-Hispanic whites (41.3%) were the least likely to have documented sputum conversion. Patients who were initially given 4 or more drugs were 36% more likely to have documented sputum conversion than those who were initially given fewer than 4 drugs, after adjusting for other factors. Patients who were under the care of chest clinics and the model TB center were about 3 times more likely to have documented sputum conversion than those under care of private physicians. Sex, recurrent TB, foreign-born status, homelessness, injecting drug use, human immunodeficiency virus infection and drug-resistant TB were not significantly associated with the documentation of sputum culture conversion. CONCLUSIONS: A substantial proportion of sputum culture-positive TB patients have no documented sputum culture conversion. The type of care provider was the predominant determinant for the documentation of sputum culture conversion.     

Tuberculosis annual report 2009--series 9. Treatment of TB (2)

The standard treatment for tuberculosis (TB) is the key to its control. Here, we report on the statistics of treatment status and the duration of hospitalization/treatment. The place of initial treatment was observed among newly notified TB patients (n = 24,170) in 2009. The proportion receiving treatment in hospital was highest (91.8%) in sputum smear-positive pulmonary TB patients (n = 9,675) including 2.3% hospitalized mainly due to other diseases. The proportion receiving treatment in hospital was the least (25.1%) among bacteriologically negative pulmonary TB cases, including 10.4 % hospitalized mainly due to other diseases. Among sputum smear-positive pulmonary TB cases the proportion of patients receiving treatment in hospital did not differ with age, but among bacteriologically negative pulmonary TB cases, this proportion differed markedly according to age group (e.g., 7.7% of those in their 20s, 24.4% of those in their 50s and 48.8% of those in their 80s). The duration of hospitalization for TB treatment among newly notified cases in 2008 was observed. The median hospitalization periods were 73 days, 78 days, 45 days, 36 days and 46 days, among new sputum smear-positive pulmonary TB cases, retreatment sputum smear-positive pulmonary TB cases, other bacillus-positive pulmonary TB cases, bacilli-negative pulmonary TB cases and extra-pulmonary TB cases, respectively. The duration of TB treatment among newly notified cases in 2008 was observed at the end of 2009. The median treatment duration among all forms of TB was 272 days. The longest median treatment duration was 286 days for retreatment of sputum smear-positive pulmonary TB cases and the shortest was 198 days for bacteriologically negative pulmonary TB cases.