结核分枝杆菌快速培养和常规药敏试验在脊柱结核治疗中的应用

目的 探讨BACT/ALERT 3D系统快速培养和绝对浓度法药敏试验对指导脊柱结核个体化化疗的应用价值,分析研究脊柱结核耐药情况.方法 根据临床表现、影像学表现、病理检查,50例患者诊断为脊柱结核,并接受手术治疗.收集术中所取脓液、干酪样组织.低温避光保存,8 h内送检,常规处理后接种液体培养基,使用BACT/ALERT 3D系统进行分枝杆菌快速培养.培养阳性者接种PNB和TCH培养基进行菌种鉴定,并将细菌接种至含药改良罗氏培养基,按绝对浓度法进行11种常用一线和二线抗结核药物药敏试验.结果 50例标本培养阳性21例(42%),人型结核杆菌19例,牛型结核杆菌2例.结核杆菌培养和药敏试验平均耗时41 d(28～58 d).其中耐药11例(52.4%),异烟肼耐药4例(19.0%),利福平和乙胺丁醇各1例(4.8%),链霉素3例(14.3%),力克肺疾2例(9.5%),左氧氟沙星8例(38.1%).结论 结核分枝杆菌快速培养和常规药敏试验准确度高,费用低,可检测常用一线和二线药物的敏感性,适用于指导脊柱结核个体化化疗方案的制定.异烟肼、利福平、吡嗪酰胺、乙胺丁醇或(和)链霉素联合用药方案对多数初治脊柱结核患者有效.

Rapid culture and conventional drug susceptibility testing of mycobacterium tuberculosis in spinal tuberculosis

Objective To assess the applicability of BACT/ALERT 3D system and absolute con- centration method in rapid culture and drug susceptibility testing of mycobacterium tuberculosis for individ- ual chemotherapy in spinal tuberculosis, and to analyse the epidemiology of drug resistance in spine tuber- culosis. Methods In this series, 50 patients were diagnozed as spinal tuberculosis based on clinical, radio- logical and histological arguments. The specimens (pus or caseous tissue) were collected during surgery, and preserved in dark cold place. After processed in a routine mycobacteriology laboratory procedure in 8 hours, the specimens were inoculated into vials of the BACT/ALERT 3D system. Mycobacterium tuberculosis strains were identified with PNB or TCH culture medium growth trial. The drug susceptibility testing was performed using absolute concentration method,which included 11 first-line and second-line antituberculous drugs. Results Twenty-one of the total 50 specimens were cultured positive(42%). Nineteen specimens were iden- tiffed as M. tuberculosis infection and 2 as M. boris. The average detection time to report drug susceptibility was 41 days (ranging from 28 to 58 days). There were 11 cases resistant to at least one drug (52.4%), 4 to isoniazid (19.0%), 1 to rifampicin (4.8%),1 to ethambutol (4.8%), 3 to streptomycin (14.3%), 2 to dipasie (9.5%), 8 to levofloxacin (38.1%). Conclusion The procedures are accurate and low-cost for first and sec- ond line antituberculous drugs susceptibility testing, and can be recommended for refining the optimal chemotherapy regimen in spinal tuberculosis. The combining usage of four or five drug regimen (isoniazid, rifampicin, pyrazinamide, ethambutol with or without streptomycin) is most efficient for initial treatment in spinal tuberculosis.