The role of Xpert MTB/RIF assay in the diagnosis of tubercular spondylodiscitis

Arockiaraj, Justin; Michael, Joy S.; Amritanand, Rohit; David, Kenny Samuel; Krishnan, Venkatesh

doi:10.1007/s00586-017-5076-9

Cited by 31 publications

(25 citation statements)

References 20 publications

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“…In this study, we have tried to find sensitivity and specificity of Gene Xpert in spinal tuberculosis cases, for which adequate literature data is not available yet. This is a prospective study and observed sensitivity of Gene Xpert is 91.18% and specificity is 100%, which correlates well with similar study by Held at al 25 showing sensitivity of 95.6% and specificity of 96.2% and for STB and study done by Arockiaraj et al 26 demonstrating sensitivity of 71.2% and specificity of 100% compared with composite reference standard. Positive predictive value is 100% and negative predictive value is 93.88% in our study, that is, negative result reliably excludes TB.…”

Section: Discussionsupporting

confidence: 90%

Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study

Solanki¹,

Basu²,

Biswas³

et al. 2019

Global Spine Journal

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Study Design: Prospective matched cohort study Objective: To evaluate the sensitivity and specificity of Gene Xpert in the diagnosis of spinal tuberculosis. Methods: From January 2016 to August 2018, Gene Xpert results were prospectively studied in 68 patients of clinicoradiologically suspected spinal tuberculosis (STB) and a control group (CG) of 92 patients, all of whom underwent computed tomography–guided/C-arm-guided/open surgical biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value are obtained using standard equations. Results: Out of 68 cases of STB, Gene Xpert was positive in 62 (true positive: 62/68) and negative in 6 (false negative: 6/68). Gene Xpert was negative for all 92 cases of CG (true negative: 92/92, false positive 0/92). Thus, in our series, sensitivity of Gene Xpert is 91.18%, specificity is 100%, positive predictive value is 100%, and negative predictive value is 93.88%. Out of all cases of STB, 62/68 (91.18%) were Gene Xpert positive, but only 35/64 (54.69%) was acid-fast bacilli (AFB) culture positive and 53/60(88.33%) was histopathologically conclusive of TB. Also, Gene Xpert was positive in 7/7 (100%) cases of STB in which histopathology were inconclusive and 25/29 (86.21%) cases of STB in which AFB culture was negative. Conclusion: In STB, Gene Xpert clearly outperforms AFB culture and histopathology due to its high sensitivity and specificity apart from being rapid in diagnosis. Hence it is justified to diagnose spinal tuberculosis by Gene Xpert though histopathology is confirmative and AFB culture remains the gold standard.

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Section: Discussionsupporting

confidence: 90%

Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study

Solanki¹,

Basu²,

Biswas³

et al. 2019

Global Spine Journal

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“…Our search yielded a total of 466 citations, 12 of which were finally included in the current meta-analysis based on the inclusion criteria ( Figure 1 and Table 1 ). 15 , 16 , 20 – 29 The included studies were published between 2014 and 2017. Data came from the People’s Republic of China, South Africa, India, and Indonesia, all of which are countries with high TB burden and low/middle income.…”

Section: Resultsmentioning

confidence: 99%

“…The CRS included all patients who have improved both clinically and radiologically after empirical antituberculous therapy where the results of culture, smear, and histology might be positive or negative for TB. 20 Moreover, the mean score of the 12 studies was 9.42 (range, 9–11) according to the criteria of QUADAS ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis

Wen

et al. 2017

IDR

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ObjectivesXpert MTB/RIF assay, a rapid and automated real-time nucleic acid amplification test, has been reported for the diagnosis of musculoskeletal tuberculosis (TB) in current years. This meta-analysis aims to determine the diagnostic accuracy of Xpert for the detection of musculoskeletal TB and rifampicin (RIF) resistance.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, and Wanfang for original articles published up to 1st June 2017 to identify studies in which the Xpert assay was applied to diagnose musculoskeletal TB. Pooled estimates were calculated using a random-effects model or a fixed-effects model according to heterogeneity. Summary receiver operating characteristic curves and the area under the curve (AUC) were used to summarize overall diagnostic performance. Deeks’ test was performed to evaluate potential publication bias.ResultsTwelve studies were identified with a pooled sensitivity and specificity of respectively 0.81 (95% confidence interval [CI] 0.78–0.83) and 0.83 (95% CI 0.80–0.86) of Xpert for the diagnosis of musculoskeletal TB. Xpert was highly sensitive (0.89, 95% CI 0.79–0.95) and highly specific (0.96, 95% CI 0.92–0.98) in detecting RIF resistance. AUC (over 0.9) suggested a relatively high level of overall diagnostic accuracy of Xpert for detecting musculoskeletal TB and RIF resistance. Prevalence and reference standard were indicated to be sources of heterogeneity between studies. No publication bias was found.ConclusionThis study provides available evidence of the rapid and effective role of Xpert in diagnosing musculoskeletal TB and detecting RIF resistance.

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“…The studies also used different culture references. Nine studies only used BACTEC MGIT 960 liquid culture as the reference, one study only used Lowenstein-Jensen solid culture as the reference [34], and four studies used both of them as references [18,22,24,35]. The performances of BACTEC MGIT 960 liquid and Lowenstein-Jensen solid cultures were different [54], which might also be one of the sources of heterogeneity among the studies.…”

Section: Discussionmentioning

confidence: 99%

“…The pooled sensitivity of Xpert MTB/RIF was 96% (I 2 = 91%; 95% CI, 90-98). The specificity of Xpert MTB/RIF ranged from 17% (95% CI, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] to 100% (95% CI, 99-100) and the pooled specificity was 85% (I 2 = 97%; 95% CI, 57-96) ( Fig 4). As expected, the sensitivity was improved, and the specificity was undervalued when compared to the culture.…”

Section: Diagnostic Accuracy Of Xpert Mtb/rif Assay For Bjtbmentioning

confidence: 99%

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

Shen¹,

Yu²,

Zhong³

et al. 2019

PLoS ONE

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BackgroundThis study aimed to evaluate the accuracy of the Xpert MTB/RIF assay for the diagnosis of bone and joint tuberculosis. MethodsWe searched databases from their inception to May 7, 2019 for published articles and reviewed them to assess the accuracy of Xpert MTB/RIF with respect to a composite reference standard (CRS) and mycobacterial culture. Meta-analyses were performed using a bivariate random-effects model, and the sources of heterogeneity were assessed via subgroup analysis and meta-regression. ResultsNineteen independent (9 prospective, 5 retrospective, and 5 case-control) studies that compared Xpert MTB/RIF with the CRS and 14 (6 prospective, 7 retrospective, and 1 case-control) studies that compared it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 81% (95% confidence interval [CI], 77-84) and 99% (95% CI, 97-100) compared to the CRS, respectively, and 96% (95% CI, 90-98) and 85% (95% CI, 57-96) compared to culture, respectively. The pooled sensitivity and specificity using pus samples vs. the CRS were 82% (95% CI, 76-86) and 99% (95% CI, 95-100), respectively. The proportions obtained while working with tissue samples vs. the CRS were 84% (95% CI, 76-90) and 98% (95% CI, 94-99), respectively. There was no significant difference in diagnostic accuracy among the types of specimens. ConclusionsXpert MTB/RIF demonstrates good diagnostic accuracy for bone and joint tuberculosis, the results of which are not related to the type of specimen.

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The role of Xpert MTB/RIF assay in the diagnosis of tubercular spondylodiscitis

Abstract: This study recommends Xpert MTB/RIF assay for early detection of Mycobacterium tubercular spondylodiscitis and Rifampicin resistance.

Cited by 31 publications

References 20 publications

Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study

Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study

Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis

Diagnostic accuracy of the Xpert MTB/RIF assay for bone and joint tuberculosis: A meta-analysis

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