Objective: To identify tools that will result in faster diagnosis, making the current pulmonary tuberculosis strategy more efficient

Patients and methods: A 4-year (2015 – 2018) retrospective study. The gold standard for diagnosis was a positive culture from a respiratory specimen. All sputum, fibroscopy and post-fibroscopy specimens (for smear negative patients) were collected. Each specimen was analyzed through smear examination and culture. All nucleic acid amplification testing results were included. Analyses looked at the incremental yield of positive cases of each successive specimen collection, and time to diagnosis.

Results: A total of 354 patients had at least one positive culture. Sputum allowed a diagnosis in 92% of cases (including a gain in sensitivity of around 7% for the third sputum specimen), with 160 smear-positive patients (45%). Among smear-negative patients, 109 underwent a fibroscopy procedure (culture sensitivity of 75%), and 59 had a post-fibroscopy specimen collected, which together identified the rest of the patients (8%). Molecular testing was used in 237 specimens. Median time to diagnosis was 11 days, which was significantly reduced among smear-negative patients when molecular testing was used (p<0.001). Shortening the delay between sputum specimen collections did not alter procedure sensitivity.

Conclusions: We identified several aspects of the French tuberculosis diagnosis algorithm that could be improved, and posed the basis for a prospective study. Centers in higher incidence areas could benefit from a dedicated, predefined procedure exploring suspicions of tuberculosis. A high suspicion score of tuberculosis could drive the reasoned use of molecular testing in such settings.

目标：确定能够加快诊断速度的工具，使当前的肺结核策略更加有效

患者和方法：一项为期 4 年（2015-2018 年）的回顾性研究。诊断的金标准是呼吸道标本培养阳性。收集所有痰液、纤维镜检查和纤维镜检查后标本（对于涂片阴性患者）。通过涂片检查和培养对每个标本进行分析。包括所有核酸扩增检测结果。分析着眼于每个连续样本收集的阳性病例的增量产量，以及诊断时间。

结果：共有354名患者至少有一种培养阳性。痰允许诊断 92% 的病例（包括第三个痰标本的敏感性增加约 7%），其中 160 名涂阳患者（45%）。在涂片阴性的患者中，109 人接受了纤维镜检查（培养敏感性为 75%），59 人收集了纤维镜检查后的标本，它们共同确定了其余患者（8%）。在 237 个样本中使用了分子测试。诊断的中位时间为 11 天，当使用分子检测时，涂片阴性患者的诊断时间显着缩短（p<0.001）。缩短痰标本采集之间的延迟并没有改变程序的敏感性。

结论：我们确定了法国结核病诊断算法的几个可以改进的方面，并为前瞻性研究奠定了基础。高发病率地区的中心可以受益于专门的、预先定义的程序来探索疑似结核病。对结核病的高怀疑评分可能会促使在这种情况下合理使用分子检测。