To evaluate the utility of Gen-Probe AccuProbes for the identification of mycobacteria directly from BACTEC TB 12B vials containing acid-fast bacilli, culture results for 11,375 clinical specimens other than blood received from 1 January 1992 to 30 September 1993 were reviewed retrospectively. During this period, a total of 359 of 11,375 BACTEC vials were positive for acid-fast bacilli and were evaluated for mycobacteria with one or more probes: 224 were probed for Mycobacterium tuberculosis complex, 253 were probed for Mycobacterium avium complex, 64 were probed for Mycobacterium kansasii, and 77 were probed for Mycobacterium gordonae. After initial testing with the probes, 75 vials were positive for M. tuberculosis complex, 99 were positive for M. avium complex, 11 were positive for M. kansasii, and 55 were positive for M. gordonae. Repeat testing of vials that were initially probe negative or testing of colonies from subcultures of these vials identified an additional 11 M. tuberculosis, 27 M. avium complex, 1 M. kansasii, and 9 M. gordonae that were not detected on initial screening. On the basis of these data, the percentage of organisms identified directly from the BACTEC TB 12B vials upon initial screening with each of the four AccuProbes was 87.2% for M. tuberculosis complex, 78.6% for M. avium complex, 91.7% for M. kansasii, and 85.9%o for M. gordonae.
To evaluate the usefulness of cytocentrifugation for detection of acid-fast bacilli (AFB) in sputum specimens, we compared this method to a traditional concentration method for the preparation of smears. A total of 844 sputum specimens (from 579 patients) of adequate volume that were submitted for detection of mycobacteria were evaluated. A portion of each specimen was used for cytocentrifugation; the remainder was processed by our decontamination-concentration protocol (2% sodium hydroxide-N-acetyl-L-cysteine; centrifugation at 3,600 ؋ g for 15 min) for preparation of smears and culture. All smears were stained with auramine O. Ninety-four cultures from 46 patients gave positive results, and AFB were seen in one or both smears from 53 specimens; 3 of the latter specimens (positive by both smear methods) were culture negative. Of the 50 AFB smear-positive and culture-positive specimens, 46 were smear positive by traditional concentration, and 47 were positive by the cytocentrifugation smear (P, not significant). Cultures of all specimens that were smear positive by only one method grew nontuberculous mycobacteria. The routine use of cytocentrifugation for concentrating sputum specimens increases the cost of smear preparation but does not increase detection of AFB by auramine O staining; however, it would be useful in handling emergent requests for AFB smears.
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