Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa

Mahwire, T C; Zunza, Moleen; Marukutira, Tafireyi; Naidoo, Paramespri

doi:10.7196/samj.2019.v109i4.13180

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…For time to MDR-TB treatment initiation, GeneXpert MTB/RIF took about 4 hours (IQR 3–6 hours) for direct smear-negative cases and 6 hours (IQR 5–7 hours) for high-risk MDR-TB cases. Again, similar to the results from other countries, such as South Korea, Latvia, and South Africa [ 48 , 49 , 50 ], conventional methods took much longer times than GeneXpert MTB/RIF. The qualitative analysis supported the use of GeneXpert MTB/RIF as a novel test to detect RR considering that the healthcare workers expressed their satisfaction with GeneXpert MTB/RIF testing, which had improved the detection rate and time to appropriate treatment for drug-resistant cases.…”

Section: Discussionsupporting

confidence: 85%

Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand

Pongpeeradech

Kasetchareo²,

Chuchottaworn³

et al. 2022

PLoS ONE

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GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. This study aimed to assess physicians’ diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results and how this affected the initiation of multidrug resistance (MDR) treatment. This study employed a mixed method: data were collected retrospectively from the medical records of TB patients and in-depth interviews were conducted with healthcare workers in areas with a high TB burden in Thailand. A total of 2,030 complete TB records from 2 patient groups were reviewed, including 1443 suspected cases with negative smear results and 587 with high risk of MDR-TB. GeneXpert MTB/RIF was routinely used to assist the physicians in their decision-making for the diagnosis of pulmonary tuberculosis (PTB) and the initiation of MDR-TB treatment. The physicians used it as a “rule-in test” for all patients with negative chest X-rays (CXR) and smear results, to ensure timely treatment. Approximately one-fourth of the patients with negative CXR/smear and GeneXpert MTB/RIF results were diagnosed with PTB by the physicians, who based their decisions on other evidence, such as clinical symptoms, and did not use GeneXpert MTB/RIF as a “rule-out test.” GeneXpert MTB/RIF proved effective in early detection within a day, thereby radically shortening the time required to initiate second-line drug treatment. Despite its high sensitivity for detecting PTB and MDR-TB, GeneXpert MTB/RIF had contradictory results (false positive and/or false negative) for 21.8% of cases among patients with negative smear results and 41.1% of cases among patients with high risk of MDR-TB. Therefore, physicians still used the results of other conventional tests in their decision-making process. It is recommended that GeneXpert MTB/RIF should be established at all points of care and be used as the initial test for PTB and MDR-TB diagnosis.

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Section: Discussionsupporting

confidence: 85%

Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand

Pongpeeradech

Kasetchareo²,

Chuchottaworn³

et al. 2022

PLoS ONE

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“…Previous studies have failed to demonstrate a reduction in mortality in RR-TB with a reduction in time to treatment initiation. 9,42 In this study analysis, the effect of being on appropriate TB therapy on mortality during the follow-up period was unclear. This implies that the association between RR-TB and 12-week mortality observed in this cohort was not mediated by diagnostic delay.…”

Section: Discussionmentioning

confidence: 92%

“…Previous studies have failed to demonstrate a reduction in mortality in RR-TB with a reduction in time to treatment initiation. 9 , 42 …”

Section: Discussionmentioning

confidence: 99%

Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis

Spies

Schutz

Ward

et al. 2022

South. Afr. j. HIV med.

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Background: Patients with HIV and drug-resistant tuberculosis (TB) are at high risk of death.Objectives: We investigated the association between rifampicin-resistant TB (RR-TB) and mortality in a cohort of patients who were admitted to hospital at the time of TB diagnosis.Method: Adults hospitalised at Khayelitsha Hospital and diagnosed with HIV-associated TB during admission, were enrolled between 2013 and 2016. Clinical, biochemical and microbiological data were prospectively collected and participants were followed up for 12 weeks.Results: Participants with microbiologically confirmed TB (n = 482) were enrolled a median of two days (interquartile range [IQR]: 1–3 days) following admission. Fifty-three participants (11.0%) had RR-TB. Participants with rifampicin-susceptible TB (RS-TB) received appropriate treatment a median of one day (IQR: 1–2 days) following enrolment compared to three days (IQR: 1–9 days) in participants with RR-TB. Eight participants with RS-TB (1.9%) and six participants with RR-TB (11.3%) died prior to the initiation of appropriate treatment. Mortality at 12 weeks was 87/429 (20.3%) in the RS-TB group and 21/53 (39.6%) in the RR-TB group. RR-TB was a significant predictor of 12-week mortality (hazard ratio: 1.88; 95% confidence interval: 1.07–3.29; P = 0.03).Conclusion: Mortality at 12 weeks in participants with RR-TB was high compared to participants with RS-TB. Delays in the initiation of appropriate treatment and poorer regimen efficacy are proposed as contributors to higher mortality in hospitalised patients with HIV and RR-TB.

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“…Xpert-MTB/RIF analysis is effective in the diagnosis of drug resistance, which enables rapid diagnosis of rifampicin resistance and timely initiation of second-line TB treatment. 41 Directly Observed Therapy (DOT) has been proved to be a cost-effective and healthimproving treatment against MDR-PTB. 42 Culture conversion has become a burst term again in recent years.…”

Section: Burst Detection For Hotspots On Medications Of Mdr-ptbmentioning

confidence: 99%

Mapping Research Trends of Medications for Multidrug-Resistant Pulmonary Tuberculosis Based on the Co-Occurrence of Specific Semantic Types in the MeSH Tree: A Bibliometric and Visualization-Based Analysis of PubMed Literature (1966–2020)

Xu¹,

Fu²,

Xu³

et al. 2023

DDDT

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Background: Before the COVID-19 pandemic, tuberculosis is the leading cause of death from a single infectious agent worldwide for the past 30 years. Progress in the control of tuberculosis has been undermined by the emergence of multidrug-resistant tuberculosis. The aim of the study is to reveal the trends of research on medications for multidrug-resistant pulmonary tuberculosis (MDR-PTB) through a novel method of bibliometrics that co-occurs specific semantic Medical Subject Headings (MeSH). Methods: PubMed was used to identify the original publications related to medications for MDR-PTB. An R package for text mining of PubMed, pubMR, was adopted to extract data and construct the co-occurrence matrix-specific semantic types. Biclustering analysis of highfrequency MeSH term co-occurrence matrix was performed by gCLUTO. Scientific knowledge maps were constructed by VOSviewer to create overlay visualization and density visualization. Burst detection was performed by CiteSpace to identify the future research hotspots. Results: Two hundred and eight substances (chemical, drug, protein) and 147 diseases related to MDR-PTB were extracted to form a specific semantic co-occurrence matrix. MeSH terms with frequency greater than or equal to six were selected to construct high-frequency co-occurrence matrix (42 × 20) of specific semantic types contains 42 substances and 20 diseases. Biclustering analysis divided the medications for MDR-PTB into five clusters and reflected the characteristics of drug composition. The overlay map indicated the average age gradients of 42 high-frequency drugs. Fifteen top keywords and 37 top terms with the strongest citation bursts were detected. Conclusion:This study evaluated the literatures related to MDR-PTB drug therapy, providing a co-occurrence matrix model based on the specific semantic types and a new attempt for text knowledge mining. Compared with the macro knowledge structure or hot spot analysis, this method may have a wider scope of application and a more in-depth degree of analysis.

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Impact of Xpert MTB/RIF assay on multidrug-resistant tuberculosis treatment outcomes in a health district in South Africa

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 5 publications

References 18 publications

Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand

Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand

Rifampicin resistance and mortality in patients hospitalised with HIV-associated tuberculosis

Mapping Research Trends of Medications for Multidrug-Resistant Pulmonary Tuberculosis Based on the Co-Occurrence of Specific Semantic Types in the MeSH Tree: A Bibliometric and Visualization-Based Analysis of PubMed Literature (1966–2020)

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