Diagnostic accuracy of three technologies for the diagnosis of multi-drug resistant tuberculosis

Alvis-Zakzuk, Nelson J.; Carrasquilla, M.; Gomez, Verónica; Robledo, Jaime; Alvis-Guzmán, Nelson; Hernandez, J. M.

doi:10.7705/biomedica.v37i3.3437

Cited by 6 publications

(3 citation statements)

References 35 publications

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“…studies (participants) PTB, summary estimates (95% CI) No. studies Rifampicin resistance, summary estimates (95% CrI) Sensitivity Specificity Sensitivity Specificity Chang 2012October201115 (8117)90% (89 to 91)98% (98 to 99)7see notesee noteWalusimbi 2013b(smear‐negative)May 201215 (2046)67% (62 to 71)98% (97 to 99)NANANASteingart 2014December 201327 (6026)89% (85 to 92)99% (98 to 99)sensitivity: 17 specificity: 2495% (90 to 97)98% (97 to 99)Yan 2016not reported12 (8122)89% (87 to 90)98% (98 to 99)NANANALi 2017June 201524 (2486)87% (83 to 90)97% (96 to 98)NANANAAlvis‐Zakzuk 2017December 2015NANANA8see notesee noteHorne 2019January 201885 (41,965)85% (82 to 87)98% (97 to 98)48 (8020)96% (94 to 97)98% (98 to 99)Abbreviations: CI: confidence interval; Crl: credible interval; NA: not applicable; PTB: pulmonary tuberculosis.Chang 2012 inc...…”

Section: Discussionmentioning

confidence: 99%

“…Li 2017 106 studies (52,410 specimens) for both PTB and extrapulmonary tuberculosis. Alvis‐Zakzuk 2017 2017 summarized accuracy of Xpert for detection of rifampicin resistance, sensitivity range 33% to 100%; specificity range 91% to 100%. Horne 2019 is this updated Cochrane Review.Systematic reviews not included in this table:Kaur 2016 did not provide summary sensitivity and specificity estimates.…”

Section: Discussionmentioning

confidence: 99%

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Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

187

157

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Background Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)‐recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis ( ). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. Objectives To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin‐resistant tuberculosis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. Selection criteria Randomized trials, cross‐sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture‐based drug susceptibility testing or MTBDR plus for rifampicin resistance. Data collection and analysis Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS‐2 and performed meta‐analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate random‐effects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. Main results We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen. Tuberculosis detection Of the total 86 studies, 45 took place in high tuberculosis burden and 50 in high TB/HIV burden countries. Most studies had low risk of bias. Xpert MTB/RIF pooled sensitivity and specificity (95% credible Interval (CrI)) were 85% (82% to 88%) and 98% (97% to 98%), (70 studies, 37,237 unselected participants; high‐certainty evidence). We found similar accuracy when ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Horne

Kohli

Zifodya

et al. 2019

Cochrane Database of Systematic Reviews

187

157

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“…That year, 3.6% of new patients and 18% of retreated patients developed RFP-resistant or multidrug-resistant tuberculosis (MDR-TB), and 450,000 patients developed drug-resistant TB (DR-TB) [ 1 ]. DR-TB, especially MDR-TB, poses many problems during diagnosis and treatment and is one of the main challenges affecting global TB prevention and control [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Whole-Genome Sequencing to Predict Mycobacterium tuberculosis Drug Resistance: A Retrospective Observational Study in Eastern China

Zhang,

Lu,

Zhu

et al. 2023

Antibiotics

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Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (MTB). Whole-genome sequencing (WGS) holds great promise as an advanced technology for accurately predicting anti-TB drug resistance. The development of a reliable method for detecting drug resistance is crucial in order to standardize anti-TB treatments, enhance patient prognosis, and effectively reduce the risk of transmission. In this study, our primary objective was to explore and determine the potential of WGS for assessing drug resistance based on genetic variants recommended by the World Health Organization (WHO). A total of 1105 MTB strains were selected from samples collected from 2014–2018 in Zhejiang Province, China. Phenotypic drug sensitivity tests (DST) of the anti-TB drugs were conducted for isoniazid (INH), rifampicin (RFP), streptomycin, ethambutol, fluoroquinolones (levofloxacin and moxifloxacin), amikacin, kanamycin, and capreomycin, and the drug-resistance rates were calculated. The clean WGS data of the 1105 strains were acquired and analyzed. The predictive performance of WGS was evaluated by the comparison between genotypic and phenotypic DST results. For all anti-TB drugs, WGS achieved good specificity values (>90%). The sensitivity values for INH and RFP were 91.78% and 82.26%, respectively; however, they were ≤60% for other drugs. The positive predictive values for anti-TB drugs were >80%, except for ethambutol and moxifloxacin, and the negative predictive values were >90% for all drugs. In light of the findings from our study, we draw the conclusion that WGS is a valuable tool for identifying genome-wide variants. Leveraging the genetic variants recommended by the WHO, WGS proves to be effective in detecting resistance to RFP and INH, enabling the identification of multi-drug resistant TB patients. However, it is evident that the genetic variants recommended for predicting resistance to other anti-TB drugs require further optimization and improvement.

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Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis

Zifodya

Kreniske

Schiller

et al. 2021

Cochrane Database of Systematic Reviews

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Diagnostic accuracy of three technologies for the diagnosis of multi-drug resistant tuberculosis

Cited by 6 publications

References 35 publications

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults

Whole-Genome Sequencing to Predict Mycobacterium tuberculosis Drug Resistance: A Retrospective Observational Study in Eastern China

Xpert Ultra versus Xpert MTB/RIF for pulmonary tuberculosis and rifampicin resistance in adults with presumptive pulmonary tuberculosis

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