The Feasibility of Xpert MTB/RIF Testing to Detect Rifampicin Resistance among Childhood Tuberculosis for Prevalence Surveys in Northern China

Abstract

Drug resistance surveillance is crucial for control of drug-resistant tuberculosis (TB). However, limited data exists on the burden of drug-resistant TB in children. The goal of this work was to generate prevalence data regarding rifampicin- (RIF-) resistant childhood TB in northern China and to test the feasibility of Xpert for surveying pediatric TB drug resistance prevalence. We enrolled 362 clinically diagnosed childhood TB patients and collected sputum, gastric lavage aspirate (GLA), bronchoalveolar lavage fluid (BALF), and cerebral spinal fluid (CSF) samples. Xpert and solid culture were utilized to detect RIF resistance. The detection rate of Xpert-positive TB among new clinically diagnosed TB cases was 38.4% (139/362), significantly higher than that of solid culture-positive TB (16.3%, 59/362, P < 0.01). Notably, Xpert-positive rates differed significantly by sample type, with the highest positive rate for GLA (51.2%). The unit testing costs per RIF-resistant TB patient were $828.41 for solid culture and $761.86 for Xpert. Our data demonstrate that the prevalence of RIF resistance among childhood TB cases in our study (6.9%) is comparable to the national RIF resistance prevalence level of new cases (6.7%). In addition, Xpert is superior to the solid culture for RIF resistance survey in the childhood TB patients.

Alternative sputum collection methods for diagnosis of childhood intrathoracic tuberculosis: a systematic literature review

“…For Xpert, it was between 2% and 17% for IS, 5% and 51% for GA and 3% and 8% for NPA. In Lu et al ,26 Xpert detected much more cases than culture (51.2 vs 19.7%) from the same GA sample.…”

“…Out of 440 records screened, 30 studies (31 articles)5–35 were included in the review (online Supplementary figure 1).…”

Diagnostic accuracy of Mycobacterium tuberculosis cell-free DNA for tuberculosis: A systematic review and meta-analysis

“…For PTB, the sensitivity of cfDNA testing was higher compared with EPTB, while the specificity was lower; however, the overall diagnostic efficacy was similar. Respiratory specimens, such as sputum and bronchoalveolar lavage fluid (BALF), are typically used to diagnose PTB but obtaining these specimens can be difficult, particularly in children [ 40 ]. Moreover, the diagnosis of PTB is difficult when the patient does not cough up sputum or is unable to collect sputum of acceptable quality.…”

The clinical diagnostic value of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in gastric aspirates

“…In the end, we got 10 articles for analysis ( Figure 1). The 10 selected articles [9][10][11][12][13][14][15][16][17][18] spanned from 2012 to 2018, of which 6 were published in Asia [9][10][11][12][13][14], 2 were published in Europe [15,16], and 2 were published in South Africa (Table 1) [17,18]. The number of study samples in each article ranged from 48 to 788, with a median of 245.5.…”