Does solid culture for tuberculosis influence clinical decision making in India?

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 5; pp. 641 - 646
• Main Authors: STALL, N, RUBIN, T, MICHAEL, J. S, MATHAI, D, ABRAHAM, O. C, MATHEWS, P, THOMAS, K, JOHN, M, DALEY, P
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-05-2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents - administration & dosage; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Culture; Culture Media; Decision Making; Extensively Drug-Resistant Tuberculosis - diagnosis; Extensively Drug-Resistant Tuberculosis - epidemiology; Female; Human bacterial diseases; Humans; India - epidemiology; Infectious diseases; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Mycobacterium; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - epidemiology; Young Adult; Asia; India; Infection; Tuberculosis; Respiratory disease; Decision making; Bacteriosis; Mycobacterial infection; Culture; Solid; Pneumology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.10.0195

SETTING: Medical units at an academic tertiary referral hospital in Southern India.OBJECTIVE: To investigate the impact of solid culture on Löwenstein-Jensen medium on clinical decision making.DESIGN: In a retrospective review of 150 culture-positive and 150 culture-negative
consecutively sampled tuberculosis (TB) suspects, treatment decisions were analysed at presentation, after the availability of culture detection results and after the availability of drug susceptibility testing (DST) culture results.RESULTS: A total of 124 (82.7%) culture-positive patients
and 35 (23.3%) culture-negative patients started anti-tuberculosis treatment prior to receiving their culture results; 101 patients (33.7%) returned for their results; two (1.3%) initiated treatment based on positive culture and no culture-negative patients discontinued treatment. DST was
performed on 119 (79.3%) positive cultures: 30 (25.2%) showed any resistance, eight (6.7%) showed multidrug resistance and one (0.84%) showed extensively drug-resistant TB. Twenty-eight patients (23.5%) returned for their DST results. Based on DST, treatment was modified in four patients (3.4%).CONCLUSION:
Using solid culture, 150 cultures need to be tested for one treatment modification and 30 for DST. The cost of the widespread application of culture will need to be balanced against its impact on treatment decisions in India.