Efficacy of the Xpert MTB/RIF Assay in Multidrug-Resistant Tuberculosis

Tabriz, Nurlan; Skak, Kuliya; Kassayeva, Lazzat T; Omarkulov, Bauyrzhan; Григолашвили, М.А.

doi:10.1089/mdr.2019.0326

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…Multi-drug-resistant TB is an increasing problem in many countries with high HIV and TB burdens, although evidence suggests it is not more frequent in people living with HIV (PLHIV) [29]. Determination of drug resistance is best accomplished with mycobacterial culture, although molecular diagnostics such as Gene Xpert MTB/RIF Ultra can provide more timely diagnosis [30,31], at the cost of some missed cases of resistance [32]. Workup for alternate infectious etiologies should include blood cultures but can otherwise be guided by any localizing signs [4]; for example, worsening pulmonary symptoms should trigger consideration of Pneumocystis jirovecci pneumonia [33] or pulmonary Kaposi Sarcoma.…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

“…Clearly this effect was not from prevention of TB alone; prevention of Cryptococcus meningitis IRIS in particular is a notable factor [178]. Several studies have assessed the value of empirical TB treatment compared to extensive screening or isoniazid preventative therapy in patients with advanced HIV and found no difference in major outcomes, suggesting that with truly rigorous screening it is possible to detect all but latent TB, although unmasking IRIS was not specifically assessed [179][180][181]. The role of TB preventative therapy in preventing unmasking TB-IRIS, and its implications for drug-resistant TB, require further exploration.…”

Section: Risk Factors and Preventionmentioning

confidence: 99%

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Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease

Quinn

Poplin

Kasibante

et al. 2020

Life

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Antiretroviral therapy (ART), while essential in combatting tuberculosis (TB) and HIV coinfection, is often complicated by the TB-associated immune reconstitution inflammatory syndrome (TB-IRIS). Depending on the TB disease site and treatment status at ART initiation, this immune-mediated worsening of TB pathology can take the form of paradoxical TB-IRIS, unmasking TB-IRIS, or CNS TB-IRIS. Each form of TB-IRIS has unique implications for diagnosis and treatment. Recently published studies have emphasized the importance of neutrophils and T cell subtypes in TB-IRIS pathogenesis, alongside the recognized role of CD4 T cells and macrophages. Research has also refined our prognostic understanding, revealing how the disease can impact lung function. While corticosteroids remain the only trial-supported therapy for prevention and management of TB-IRIS, increasing interest has been given to biologic therapies directly targeting the immune pathology. TB-IRIS, especially its unmasking form, remains incompletely described and more data is needed to validate biomarkers for diagnosis. Management strategies remain suboptimal, especially in the highly morbid central nervous system (CNS) form of the disease, and further trials are necessary to refine treatment. In this review we will summarize the current understanding of the immunopathogenesis, the presentation of TB-IRIS and the evidence for management recommendations.

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Section: Clinical Features and Diagnosismentioning

confidence: 99%

Section: Risk Factors and Preventionmentioning

confidence: 99%

Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease

Quinn

Poplin

Kasibante

et al. 2020

Life

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“…Similar to our results, studies in Russia and South Africa found nonsignificant trends towards improved treatment outcomes with the use of Xpert assay [ 17 , 25 ]. In contrast, a large study of 952 MDR-TB patients in Kazakhstan found that the use of the Xpert versus culture-based methods was associated with a much higher rate of favorable outcomes (74 vs 49%, P < .0001) [ 26 ]. An important point to note is that our study and those mentioned above were carried out before the full implementation of new drug regimens for drug-resistant TB, which are shorter and more effective than prior second-line treatment regimens and may help realize the full impact of molecular tests among patients with drug resistance disease [ 8 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF Use Is Associated With Earlier Treatment Initiation and Culture Conversion Among Patients With Sputum Smear-Negative Multidrug-Resistant Tuberculosis

Kipiani

Graciaa

Buziashvili

et al. 2021

Open Forum Infectious Diseases

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Background While rapid molecular diagnostic tests for tuberculosis (TB) have decreased detection time of M. tuberculosis and drug resistance, whether their use improves clinical care and outcomes is uncertain. To address these knowledge gaps, we evaluated whether use of the Xpert MTB/RIF assay impacts treatment and clinical outcome metrics among patients treated for sputum smear-negative multidrug-resistant (MDR)-TB. Methods A retrospective cohort of adult patients initiating treatment for sputum smear-negative MDR-TB at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia from 2011-2016. The Xpert MTB/RIF was introduced in Georgia in 2010 and implemented into programmatic use in 2014. Exposure was availability of an Xpert result at time of diagnosis. Time to second-line treatment initiation, sputum culture conversion, and end-of-treatment outcomes were determined from. Time to event was compared using a Cox proportional hazards model. Results Among 151 patients treated for sputum smear-negative MDR-TB (96% culture positive), the Xpert was utilized in the clinical management of 78 (52%) patients and not used in 73 (48%). An adjusted analysis controlling for potential confounders found that patients in the Xpert group had shorter median time to second-line treatment (13 vs. 56 days, adjusted hazard ratio [aHR]10.21, p<0.0001) and culture conversion (61 vs. 93 days, aHR 1.93, p<0.001). There was no difference in treatment outcomes. Conclusions Use of the Xpert in the management of sputum smear-negative MDR-TB decreases time to second-line therapy and sputum culture conversion, providing evidence of its clinical impact and supporting its programmatic utility.

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“…These kits only screen the amino acid sequence and not the nucleic acid sequence so silent mutations will go undetected [ 14 ]. Therefore, solitary reliance on genotypic drug resistance detection would underestimate the disease burden and drug resistance rates [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Molecular tests cannot differentiate between members of the MTB complex. They are unable to differentiate between viable and nonviable bacteria DNA; hence, they cannot be used for monitoring the progression or success of treatment of patients with ATT [15]. Overall drug resistance incidence (patients who came drug resistant) was 12.5% (5/40 cases).…”

Section: Dst Interpretationsmentioning

confidence: 99%

Drug Resistance in Osteoarticular Tuberculosis: A Study From an Endemic Zone

Gain,

Jain,

Bhalla

et al. 2023

Cureus

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Background: The present study was undertaken to determine the incidence of drug resistance against anti-tubercular drugs among patients from an endemic zone. Methodology: Forty consecutive clinico-radiologically diagnosed patients of osteoarticular tuberculosis (29: spine, 11: extraspinal) were enrolled. Pus from needle aspiration was taken in 31 cases, tissue following spinal decompression in seven, synovial in one, and sinus edge biopsy in one. The pus/tissue was subjected to acid-fast bacilli (AFB) staining and liquid culture, sensitivity to 13 anti-tubercular drugs (Isoniazid (INH), rifampicin (RIF), kanamycin (KAN), amikacin (AMK,) capreomycin (CAP), ethionamide (ETH), levofloxacin (LEV), moxifloxacin (MOX), linezolid (LNZ), para-amino-salicylic acid (PAS), bedaquiline (BDQ), delamanid (DLM), and clofazimine (CFO)) were checked, and histopathological/cytopathological examination and molecular tests were performed. Results: The mean age of patients was 29.07(9-65) years; 21 were female and 19 were male. The diagnostic accuracy for tuberculosis was 20% by AFB smear, 65% by liquid culture, 82.5% by histopathology, and 90% by cartridge-based nucleic acid amplification testing (CBNAAT). All culture-positive isolates were identified as Mycobacterium tuberculosis with no non-tubercular Mycobacterium . The drug resistance detected on CBNAAT was 11.1%, line probe assay (LPA) first line was 15.4%, LPA second line was 4%, and liquid drug susceptibility testing (DST) 11.5%. We detected 15.4% INH resistance, 11.1% RIF, 7.6% LEV, 3.8% MOX and PAS. No resistance was detected against second-line injectable drugs (SLID), ETH, LNZ, BDQ, DLM, and CFO. Conclusions: No single laboratory modality can ascertain the diagnosis in all cases; hence, samples should be sent for all tests in tandem. In the presence of insufficient samples, tissue may be subjected to CBNAAT and histopathology to arrive at tissue diagnosis. In this subset, overall drug resistance incidence was 12.5% (5/40) with one patient each of isolated INH and RIF resistance, one of multidrug-resistance (MDR), and two of pre-extensively drug-resistant (pre-XDR). Primary drug resistance came out to be 11.1% (4/36) with one patient each of isolated INH and RIF resistance, one of MDR, and one Pre-XDR.

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Efficacy of the Xpert MTB/RIF Assay in Multidrug-Resistant Tuberculosis

Cited by 5 publications

References 12 publications

Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease

Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease

Xpert MTB/RIF Use Is Associated With Earlier Treatment Initiation and Culture Conversion Among Patients With Sputum Smear-Negative Multidrug-Resistant Tuberculosis

Drug Resistance in Osteoarticular Tuberculosis: A Study From an Endemic Zone

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