Blood cultures for the diagnosis of multidrug-resistant and extensively drug-resistant tuberculosis among HIV-infected patients from rural South Africa: a cross-sectional study.
BACKGROUND
The yield of mycobacterial blood cultures for multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) among drug-resistant TB suspects has not been described.


METHODS
We performed a retrospective, cross-sectional analysis to determine the yield of mycobacterial blood cultures for MDR-TB and XDR-TB among patients suspected of drug-resistant TB from rural South Africa. Secondary outcomes included risk factors of Mycobacterium tuberculosis bacteremia and the additive yield of mycobacterial blood cultures compared to sputum culture.


RESULTS
From 9/1/2006 to 12/31/2008, 130 patients suspected of drug-resistant TB were evaluated with mycobacterial blood culture. Each patient had a single mycobacterial blood culture with 41 (32%) positive for M. tuberculosis, of which 20 (49%) were XDR-TB and 8 (20%) were MDR-TB. One hundred fourteen (88%) patients were known to be HIV-infected. Patients on antiretroviral therapy were significantly less likely to have a positive blood culture for M. tuberculosis (p = 0.002). The diagnosis of MDR or XDR-TB was made by blood culture alone in 12 patients.


CONCLUSIONS
Mycobacterial blood cultures provided an additive yield for diagnosis of drug-resistant TB in patients with HIV from rural South Africa. The use of mycobacterial blood cultures should be considered in all patients suspected of drug-resistant TB in similar settings.
Tugela Ferry Care and Research Collaboration, Tugela Ferry, South Africa. scott.heysell@gmail.com
Scott K
SK
Heysell
Tania A
TA
Thomas
Neel R
NR
Gandhi
Anthony P
AP
Moll
François J
FJ
Eksteen
Yacoob
Y
Coovadia
Lynette
L
Roux
Palav
P
Babaria
Umesh
U
Lalloo
Gerald
G
Friedland
Sarita
S
Shah
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000150:complications / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054908:Extensively Drug-Resistant Tuberculosis / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D055815:Young Adult