Diagnostic accuracy of Xpert MTB/RIF for tuberculosis detection in different regions with different endemic burden: A systematic review and meta-analysis

Abstract

PurposeTo estimate the diagnostic accuracy of Xpert MTB/RIF, a systematic review and meta-analysis were carried out.MethodsUp to June 20, 2015, multiple databases were screened for relevant studies.ResultsAccordingly, 106 studies included 52,410 samples were selected. Diagnostic accuracy of Xpert MTB/RIF for TB detection was validated against either culture or a composite reference standard (CRS). Additionally, selected studies were further subgrouped in four groups based on sample’s type, subject’s age, status of HIV co-infection and smear-positivity. The overall pooled sensitivity and specificity of Xpert MTB/RIF was 0.85 (95% confidence interval [CI] 0.82–0.88) and 0.98 (95% CI 0.96–0.98), respectively, compared to culture; while it was 0.59 (95% CI 0.44–0.72) and 0.99 (95% CI 0.97–1.00) compared to CRS. The overall sensitivity was lower in countries with high TB prevalence than countries with middle/low prevalence (0.84, 95% CI: 0.80–0.88 versus 0.89, 95% CI: 0.84–0.93). Furthermore, Xpert MTB/RIF has higher sensitivity in patients with positive smears (0.99, 95% CI 0.97–0.99), in patients with pulmonary TB samples (0.87, 95% CI 0.83–0.90), in adults (0.82, 95% CI 0.76–0.86) and in HIV-positive patients (0.81, 95% CI 0.73–0.87).ConclusionsTaken together, Xpert MTB/RIF is a quick and accurate diagnostic assay for TB which will significantly help the physicians to make their clinical decisions.

Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data

“…There is substantial unexplained heterogeneity in the sensitivities of tuberculosis diagnostics in people with HIV. 11,[37][38][39] Our results show that substantial variation in sample availability has an even greater effect on diagnostic yield in critically ill patients with M tuberculosis BSI. We found that the probability of obtaining sputum and urine was reduced in the sickest patients, a considerable concern for the WHO algorithm, as reliance on these rapid diagnostics might be delaying treatment in patients at greatest risk of death.…”

Towards next generation diagnostics for tuberculosis: identification of novel molecular targets by large-scale comparative genomics

“…This has been probably motivated by the fact that current molecular tools have shown to perform well in most of situations. For instance, assays targeting the insertion sequence IS6110 ([46] or rpoB [47]. However, the available tools are not enough to stop the spread of the disease and for this reason many new generation diagnostics are still being developed with the aim to improve the accuracy of the existing ones and tackle their known flaws.…”

Comparison of a Rapid Molecular Method with Conventional Methods for Identification of Mycobacterium tuberculosis complex and Detection of Rifampicin Resistance

“…Dünyanın birçok bölgesinde yapılmış çalışmalarda, GX testinin tanı performansı açısından oldukça değişken duyarlılık sonuçları elde edilmiştir (14)(15)(16)(17)(18) . Bu değişkenlik çalışmaya alınan örneklem boyutu, çalışma grubundaki TB insidansı, akciğer ve akciğer dışı örnek türlerinin dağılımı, örnek kalitesi ve çalışmalarda mikroskopik incelemede ARB görülen örnek oranındaki farklara bağlı olmaktadır (9)(10)(11)(15)(16)(17)(18) .…”

“…Li ve ark. (14) tarafından 106 çalışmanın incelendiği bir meta-analizde, çalışmamızdakine benzer olarak testin duyarlılığının akciğer örneklerinde akciğer dışı örneklere göre yüksek bulunduğunun vurgulanması bu testin akciğer örnekleri için daha uygun olduğunu düşündürmektedir. Düşük duyarlılık, özellikle ARB negatif bulunan örneklerde akciğer dışı TB tanısını dışlamada testin kullanımını kısıtlamaktadır (15,18) .…”