Molecular drug susceptibility testing in the Netherlands: performance of the MTBDR<I>plus</I> and MTBDR<I>sl</I> assays

Abstract

The MTBDRplus and MTBDRsl assays may aid in decision making in tuberculosis treatment in low-level drug resistance settings and should preferably be used to exclude resistance.

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

“…Although these tests are technically more demanding and require more expertise of the laboratory staff involved, this offers a high degree of confidence in the diagnosis of MDR-TB [48]. Nevertheless, it remains important to establish the positive and negative predictive value of LPA in each geographic region where they are implemented [49]. Clinicians should not be confronted only with the specific details of the results of such tests, but with probabilities that MTB is resistant, or MDR.…”

“…Clinicians should not be confronted only with the specific details of the results of such tests, but with probabilities that MTB is resistant, or MDR. Especially in the molecular detection of resistance against fluoroquinolones and amino glycosides, detection of a mutation in particular genomic targets of MTB does not always imply resistance [49]; the predictive value of each mutation differs significantly, and expertise in translating laboratory findings into predictive values for clinicians is of the utmost importance. For more information on genes and mutations, we refer to more dedicated in-depth reviews [47] The next step in the molecular detection of MDR-and XDR-TB is whole-genome sequencing (WGS).…”

Current status and opportunities for therapeutic drug monitoring in the treatment of tuberculosis

“…[73] For the frequently observed mutations tested in reverse line blot assays, such as the ones associated with rifampicin and isoniazid, the positive-and negative-predictive value is high and this merits direct clinical use of these test results to steer the treatment. [74] For other drugs, especially of the second-line category (Table 2), the predictive value is sometimes somewhat lower and this confuses the utility of this information. A part of the current confusion may well be caused by the low reproducibility of phenotypic resistance testing along with the fact that in reverse line blot assays only a small subset of the resistance mutations is revealed.…”

Letter to editor: Emerging epidemic of drug resistant tuberculosis in vulnerable populations of developing countries

“…Line probe assays (LPAs), have been developed to replace current conventional tests. LPA can detect resistance to first and second line anti-tuberculosis drugs in less than 1 day 15 . The advance in PCR, sequencing, and oligonucleotide assay have increased the sensitivity, specificity, and speed of these tests 16 .…”