Mixed impact of Xpert<sup>®</sup> MTB/RIF on tuberculosis diagnosis in Cambodia

Auld, Sara C.; Moore, Brittany K.; Kyle, Ryan P.; Nong, Kailei; Pevzner, Eric; Eam, Khun Kim; Eang, Mao Tan; Killam, W P

doi:10.5588/pha.16.0001

Cited by 8 publications

(4 citation statements)

References 16 publications

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“… 22 - 25 In a study conducted in Rwanda, in which both methods were applied in the same group of patients, Ngbonziza et al found a 32.3% gain in diagnostic power, 22 whereas Cowan et al reported a 69.0% diagnostic gain in a study conducted in Mozambique. 23 In a population of 401 HIV-infected individuals in Cambodia, Auld et al 24 reported a diagnostic gain of only 26.0% attributed to the use of the Xpert MTB/RIF test. Evaluating routine program data in 18 countries, Ardizzoni et al 25 observed that the use of the Xpert MTB/RIF test resulted in a mean relative diagnostic gain of 42.3% over the use of sputum smear microscopy.…”

Section: Discussionmentioning

confidence: 99%

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

et al. 2018

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Objective:To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods:This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results:Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions:The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

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Section: Discussionmentioning

confidence: 99%

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

et al. 2018

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“…A revised guidelines were published in 2013 endorsing the use for diagnostic pulmonary TB, pediatric TB, extrapulmonary TB, rifampicin resistance, and for TB/HIV coinfection cases. In Brazil, this rapid molecular test (TRM) was introduced, in 2014 [ 6 , 7 ]. However, conventional methods of smears and cultures continue to be considered the gold standard for diagnosis and monitoring the treatment for TB, despite their limitations such as low sensitivity and long incubation period [ 8 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

Tomaz¹,

Raboni²,

Kussen³

et al. 2021

PLoS ONE

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Xpert® MTB/RIF has been widely used for tuberculosis (TB) diagnosis in Brazil, since 2014. This prospective observational study aimed to evaluate the performance of Xpert in different contexts during a two-year period: (i) laboratory and clinical/epidemiological diagnosis; (ii) HIV-positive and -negative populations; (iii) type of specimens: pulmonary and extrapulmonary. Overall, 924 specimens from 743 patients were evaluated. The performance of the assays was evaluated considering culture (Lowenstein Jensen or LJ medium) results and composite reference standard (CRS) classification as gold standard. According to CRS evaluation, 219 cases (29.5%) were classified as positive cases, 157 (21.1%) as ‘possible TB’, and 367 (49.3%) as ‘not TB’. Based on culture, Xpert and AFB smear achieved a sensitivity of 96% and 62%, respectively, while based on CRS, the sensitivities of Xpert, AFB smear, and culture were 40.7%, 20%, and 25%, respectively. The pooled sensitivity and specificity of Xpert were 96% and 94%, respectively. Metric evaluations were similar between pulmonary and extrapulmonary samples against culture, whereas compared to CRS, the sensitivities were 44.6% and 29.3% for the pulmonary and extrapulmonary cases, respectively. The Xpert detected 42/69 (60.9%) patients with confirmed TB and negative culture on LJ medium, and 52/69 (75.4%) patients with negative AFB smear results. There was no significant difference in the diagnostic accuracy based on the types of specimens and population (positive- and negative-HIV). Molecular testing detected 13 cases of TB in culture-negative patients with severe immunosuppression. Resistance to rifampicin was detected in seven samples. Herein, Xpert showed improved detection of pulmonary and extrapulmonary TB cases, both among HIV-positive and -negative patients, even in cases with advanced immunosuppression, thereby performing better than multiple other diagnostic parameters.

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“…In contrast, Brum et al reported that the Xpert test is sensitive and specific in cases of pulmonary TB among populations living with HIV, thereby showing diagnostic and treatment benefits, especially in cases with negative smear results [52,53]. Auld et al concluded that the molecular test contributed to an increase in TB-MDR detection and observed a decline in the empirical treatment of this population, contributing to timely diagnosis and treatment [7].…”

Section: Plos Onementioning

confidence: 99%

“…A revised guidelines were published in 2013 endorsing the use for diagnostic pulmonary TB, pediatric TB, extrapulmonary TB, rifampicin resistance, and for TB/HIV coinfection cases. In Brazil, this rapid molecular test (TRM) was introduced, in 2014 [6,7]. However, conventional methods of smears and cultures continue to be considered the gold standard for diagnosis and monitoring the treatment for TB, despite their limitations such as low sensitivity and long incubation period [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Mixed impact of Xpert^® MTB/RIF on tuberculosis diagnosis in Cambodia

Abstract: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC.

Cited by 8 publications

References 16 publications

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

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Mixed impact of Xpert® MTB/RIF on tuberculosis diagnosis in Cambodia

Abstract: Although utilization of Xpert was low, it may have contributed to an increase in evaluations for possible MDR-TB and a decline in empiric treatment for PLHIV when available as POC.

Cited by 8 publications

References 16 publications

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

The Xpert® MTB/RIF diagnostic test for pulmonary and extrapulmonary tuberculosis in immunocompetent and immunocompromised patients: Benefits and experiences over 2 years in different clinical contexts

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Mixed impact of Xpert^® MTB/RIF on tuberculosis diagnosis in Cambodia