Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
Objective To evaluate the diagnostic value of all diagnostic tests for detecting armazide resistance in mycobacterium tuberculosis. Methods We searched PUBMED, EMBASE, CBM, CSJD and CJFD. QUADAS items were used to evaluate the quality of included studies. Meta-disc software was used to handle data from included studies. Results Twelve studies were included. Meta-analyses showed that the summary sensitivity and summary specificity of nitrate reductase assay were 92% and 99%, and those of BACTEC MGIT 960 system were 93% and 96%, respectively. The SROC of nitrate reductase assay and BACTEC MGIT 960 system were 0.9836 and 0.9862, respectively. Conclusion We recommend that proportion method can be replaced by nitrate reductase assay as a screening test for detecting armazide resistance in mycobacterium tuberculosis, and BACTEC 460 can be replaced by BACTEC MGIT 960 system as a final diagnostic test for detecting armazide resistance in mycobacterium tuberculosis.
Objective To analyze the clinical characteristics of Mycobacterium tuberculosis (Mtb) infection of the sternum after cardiac surgery. Methods A computerized search was conducted in PubMed, Web of Science, Wanfang, and CNKI databases for published case reports of post-cardiac surgery sternal Mtb infections up to July 18, 2023. Two researchers independently screened the included cases, extracted relevant data, and analyzed clinical features. Results A total of 15 articles involving 26 patients were included, comprising 16 males and 10 females, with a mean age of (61.9±15.6) years (range 5-80). Previous surgical histories included coronary artery bypass grafting (14 patients, 53.8%), valve surgery (8 patients, 30.8%), congenital heart disease surgery (3 patients, 11.5%), and aortic surgery (2 patients, 7.7%). The main symptoms and signs were wound abscesses and poor healing, often accompanied by pain, with or without redness and swelling, while systemic symptoms such as low-grade fever, night sweats, and weight loss were typically absent. The median time for infection to be discovered in 13 patients after surgery was 10.0 (3.0, 13.0) months, and the median interval between infection discovery and diagnosis in 9 patients was 3.0 (2.0, 6.0) months. The primary diagnostic methods included Mtb culture, histopathology, and acid-fast staining of debrided bone tissue or pus. One patient died of cardiac arrest before diagnosis. Among the 25 diagnosed patients, 13 received only antitubercular therapy (11 of whom had undergone surgical treatment before diagnosis), while 12 received combined antitubercular and surgical treatment. All 25 patients were successfully cured, with antitubercular therapy lasting 6-12 months. Conclusion Post-cardiac surgery sternal Mtb infection has a prolonged latency period and poses significant diagnostic challenges, leading to high rates of missed and misdiagnosed cases. Timely diagnosis and treatment can markedly improve prognosis.
目的 探讨肾移植患者非结核分枝杆菌（NTM）病临床特点及分子诊断。 方法 回顾性分析2011年4月1例皮肤软组织NTM感染的肾移植患者的临床特点，并以其病变组织DNA为模板，聚合酶链反应（PCR）扩增hsp65基因和rpoB基因序列，测序比对鉴定其NTM菌种。结合文献复习NTM病及分析分子生物学技术在移植患者NTM感染诊断中的作用。 结果 该肾移植患者系皮肤软组织胞内分枝杆菌感染，临床特点与结核病极其相似，难以进行鉴别诊断。PCR扩增、测序的结果显示hsp65产物和rpoB产物序列与胞内分枝杆菌GeneBank中FJ643456.1及CP003324.1序列100%一致。 结论 NTM病的临床表现与结核病相似，分子生物学方法鉴定菌种对移植患者胞内分枝杆菌病的诊断有帮助。
Objectives To evaluate the effect and safety of mycobacterium vaccae in the treatment of recurrent treated pulmonary tuberculosis. Methods We searched PubMed (1997 to 2006), VIP (1997 to 2006), Wanfang database (1997 to 2006), The Cochrane Central Register of Controlled Trials (Issue 4, 2006) and the National Research Register (1996 to 2006). Randomized controlled trials comparing the mycobacterium vaccae immunotherapy group and the control group were included. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 4.2.2 software by The Cochrane Collaboration. Results Eleven high quality trials were included. Meta-analyses showed that mycobacterium vaccae immunotherapy plus chemotherapy resulted in higher sputum negative conversion rate (RR=1.36, 95%CI 1.21 to 1.54), higher lesion absorption rate (RR=1.39, 95%CI 1.13 to 1.72), and lower lesion non-absorption rate (RR=0.46, 95%CI 0.36 to 0.60), compared with the control group. These differences were all statistically significant. No serious adverse events were reported. Conclusion As an adjunct to chemotherapy, mycobacterium vaccae is helpful for patients with recurrent treated pulmonary tuberculosis in terms of improving cell-medicated immunity, sputum negative conversion and X-ray manifestation. More high quality studies are needed for further analysis.
Objective To evaluate the diagnostic value of all diagnostic tests detecting the ethambutol resistance in Mycobacterium tuberculosis. Methods PubMed, EMbase, Chinese Biomedical Database (CBM), Chinese Scientific Journals Full-Text Database (CSJD), and Chinese Journal Full-text Database (CJFD) were searched, and QUADAS items were used to evaluate the quality of included studies. Meta-disc software was used to handle data from included studies. Such index as sensitivity, specificity, and SROC were applied to assess the diagnostic value of individual diagnostic test. Results Nine studies were included. The results of meta-analyses showed that compared with proportion method, the summary sensitivity, summary specificity, positive likelihood ratio, negative likelihood ratio, and SROC area under curve of a nitrate reductase assay were 92%, 99%, 30.50, 0.13, and 0.975 2, respectively, while compared with BACTEC 460 TB, the above mentioned indexes of BACTEC MGIT 960 System were 92%, 99%, 6.27, 0.11, and 0.9, respectively. Bacteriophage biological amplification method revealed relative good analysis effectiveness on MB/BacT. Conclusion According to the results, it is recommended that nitrate reductase assay can replace proportion method as screening test of ethambutol resistance in Mycobacterium tuberculosis, and BACTEC MGIT 960 System can replace BACTEC 460 as final diagnostic test of ethambutol resistance in Mycobacterium tuberculosis.
【摘要】 目的 分析成都市近年一线抗结核药的耐药状况，为耐药结核病预防控制提供依据。 方法 对成都市2007年1月-2009年12月就诊的结核患者，临床分离株培养鉴定为结核分枝杆菌的菌株采用绝对浓度法进行一线抗结核药:链霉素（SM）、异烟肼（INH）、利福平（RF）、乙胺丁醇（EMB）耐药性检测，分析结核分枝杆菌的耐药情况。 结果 1 235例结核患者中，总耐药率和总耐多药率分别为28.83%、14.01%，初始耐药率和获得性耐药率分别为12.82%、61.27%。近3年耐多药率有下降趋势，但获得性耐药率呈逐年上升趋势。 结论 成都市结核耐药状况仍然比较严重，进一步加强耐药结核的监测和控制非常重要。【Abstract】 Objective To analyze the drug resistant treating mycobacterium tuberculosis (MTB) in Chengdu in recent three years, and to provide the evidence for tuberculosis controlling. Methods The patients with MTB diagnosed from January 2007 to December 2009 in Chengdu were enrolled. Absolute concentration method was used to test the drug-resistance of streptomycin (SM), isoniazide (INH), rifampicin (RFP), and ethambutol (EMB). Results The total rate of drug resistance and multi-drug resistance were 28.83% and 14.01% respectively. The rates of initial drug resistance and the acquired drug resistance were 12.88% and 61.27% respectively. Multi-drug resistance rate showed a downward trend, but the rate of acquired drug resistance increased gradually. Conclusion The situation of drug resistance of tuberculosis in Chengdu is still serious, and it′s very important to further monitor and control the drug resistance treating tuberculosis.
ObjectiveTo systematically review the diagnostic value of PCR-single-strand conformational polymorphism (PCR-SSCP) method for detecting rpoB gene mutation of rifampin-resistant mycobacterium tuberculosis. MethodsSuch databases as PubMed, Web of Science, The Cochrane Library (Issue 2, 2014), CBM, VIP and WanFang Data were electronically and comprehensively searched for relevant studies on the diagnostic value of PCR-SSCP method for detecting rpoB gene mutation of rifampin-resistant mycobacterium tuberculosis from inception to January 1st, 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Meta-analysis was then conducted using Meta-Disc 1.4 and Stata 12.0. ResultsA total of 10 studies were included involving 1 299 cases. The results of meta-analysis showed SEN=0.92 (95%CI 0.90 to 0.94, P=0.019 3), SPE=0.97 (95%CI 0.95 to 0.98, P < 0.000 1), +LR=23.68 (95%CI 8.71 to 64.37, P < 0.000 1), -LR=0.10 (95%CI 0.06 to 0.15, P=0.023 1), DOR=257.16 (95%CI 96.82 to 683.02, P=0.020 0), and SROC area under the curve (AUC) was 0.971 5, and Q* was 0.922 3. The results of sensitivity analysis (after removing studies with sample size less than 100, Chinese studies and QUADAS more than 10 studies) showed that, the results were stable with reliable conclusion. ConclusionPCR-SSCP method has a fairly high value in the diagnosis of rpoB gene mutation of rifampinresistant mycobacterium tuberculosis.