Rapid detection of resistant tuberculosis by nitrate reductase assay performed in three settings in Brazil

Shikama, Maria de Lourdes; Silva, Regina Ruivo Ferro e; Martins, Maria Conceição; Giampaglia, Carmen Maria Saraiva; Oliveira, Rosângela Siqueira de; Silva, Rosmari F. A. M.; Silva, Paula Ferro E.; Telles, María Alice da Silva; Martin, Anandi; Palomino, Juan Carlos

doi:10.1093/jac/dkp284

Cited by 13 publications

(11 citation statements)

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“…NTM were identified initially when readings of DNRA (absence of color) and DPM (growth on PNB containing LJ-slopes) were taken and further confirmed by growth characteristics, pigmentations, and certain biochemical tests. Our results for all four used drugs were also similar to those obtained by other authors with the indirect NRA [28,29] and also comparable with direct NRA [18,20]. We have compared the DNRA assay with those of DPM as Musa et al [26] and INRA with the internationally accepted gold standard IPM.…”

Section: Discussionsupporting

confidence: 88%

“…Additionally, Shikama et al [35] stated 100% sensitivity and specificity of NRA for RIF with a TAT of 15 days. In another study, Shikama et al [18] found the reproducibility of NRA was 100% for INH and EMB and 97% for STR and RIF. Percent agreement between the results of NRA and PM was superb for INH and RIF, i.e., 98.3%.…”

Section: Discussionmentioning

confidence: 94%

“…Some examples of the direct tests are nitrate reductase assay (NRA); microscopic observation drug susceptibility (MODS) assay; and molecular assays such as the Genotype MTBDR (Hain Life sciences, Nehren, Germany), and its newer version, the Genotype MTBDRplus [11][12][13][14]. Although a number of studies have been conducted to evaluate the performance of direct NRA [15][16][17][18], to the best of our knowledge only two are from India [19,20]. The present study was conducted to evaluate the performance of direct NRA in a region of northern India.…”

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confidence: 99%

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Direct drug susceptibility testing of Mycobacterium tuberculosis against primary anti-TB drugs in northern India

Gupta

Anupurba

2010

J Infect Dev Ctries

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Introduction: The present study aimed to evaluate a rapid and inexpensive colorimetric nitrate reductase assay (NRA) performed directly on sputum specimens for detection of drug resistance in Mycobacterium tuberculosis (MTB). Methodology: A total of 55 sputum samples were decontaminated and processed by modified Petroff's method. A part of the resulting suspension was used to perform direct NRA (DNRA) and direct proportion method (DPM) analysis. Of the 55 samples, 45 could be used to compare the two methods. Indirect drug sensitivity testing (DST) was also done for 14 MTB strains. Results: Excellent agreement was found between DNRA and DPM testing with κ values of 1, 0.91, 0.91, and 1 for RIF, INH, STR and EMB respectively. The sensitivities and specificities of DNRA compared to that of DPM were observed to be 100 and 100%, 100 and 93%, 95 and 96%, 100 and 100 % for RIF, INH, STR, and EMB respectively. Comparing the results of DNRA, DPM and indirect NRA with those of the gold standard indirect PM for 14 MTB strains showed that sensitivities, specificities and percent agreements were 100, 100 and 100% for all four tested drugs. Results for most of the specimens (55.6%) were available in 21 days with DNRA. Conclusions: We have saved valuable time by omitting the pre-isolation step and conclude that DNRA is a rapid, accurate and inexpensive method for direct DST of MTB and may become an appropriate alternative method for the resource limited settings.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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Direct drug susceptibility testing of Mycobacterium tuberculosis against primary anti-TB drugs in northern India

Gupta

Anupurba

2010

J Infect Dev Ctries

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“…The current findings with these two drugs agreed with previous and recent data for nitrate reductase assay (5,21,22), demonstrating insufficient concordance of the assay with the normally recommended standards to recommend them for routine use. Nonetheless, Rosales et al (23) have recently evaluated the nitrate reductase assay for the rapid detection of resistance to secondline drugs such as ofloxacin and kanamycin.…”

Section: Discussionsupporting

confidence: 48%

Utilidad del ensayo de nitrato reductasa en la detección de Mycobacterium tuberculosis multirresistente en caso de recursos limitados

López

Álvarez

2011

biomedica

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Introduction. The performance of a drug susceptibility test may change when moving from the research stage to implementation on a population level in actual public health practice. Objective. The performance of a rapid drug susceptibility test was described for detecting multidrugresistant Mycobacterium tuberculosis when implemented in the routine workflow of a low-resource reference laboratory. Materials and methods. A prospective study was done comparing the performance of the nitrate reductase assay with the conventional proportion method for rifampicin and isoniazid on 364 isolates were obtained from multidrug-resistant tuberculosis risk patients referred from diffrent Colombian laboratories.Results. When compared with the proportion method, the nitrate reductase assay sensitivity was 86.8% and 84.9% for rifampicin and isoniazid, respectively, whereas nitrate reductase assay specificity was 100% for isoniazid and rifampicin. Nitrate reductase assay sensitivity was significantly higher when the age of isolate was less than 70 days. A sensitivity of 94.4% dropped to 78.1% for rifampicin resistance for fresh and old isolates, respectively (Fisher exact test, p=0.05). For isoniazid resistance using fresh and old isolates, 94.7% vs.74.3% sensitivities, were achieved (chi square test, p=0.03). The proportion of nitrate reductase assay ambiguous results was significantly higher in multidrug-resistant than in nonmultidrug-resistant isolates (17.6% vs. 4.0%, chi square test, p<0.005). Conclusions.The nitrate reductase assay demonstrated provided reliable results for antibiotic resistance. However, using old cultures leds to a higher proportion of false sensitive results; furthermore, the nitrate reductase assay capability to detect multidrug-resistant tuberculosis decreased due to a higher proportion of non-interpretable results.

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“…10 The percentage agreement of 98.3%, 98.3%, 90.8% and 93.3% by NRA for INH, RMP, SM and EMB respectively, were observed in Brazilian study. 11 However, marginally lower sensitivity and specifi city for STR and EMB have also been reported. 12,7 For STR and EMB testing, further studies are required to optimize preparation of adequate inoculum and drug concentration in order to avoid strain misclassifi cation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Nitrate Reductase Assay for Rapid Detection of Drug Resistant Tuberculosis

Sah

Bhatta

Ghimire

et al. 2013

SAARC J. Tuber. Lung Dis. HIV/AIDS

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Rapid detection of resistant tuberculosis by nitrate reductase assay performed in three settings in Brazil

Abstract: The data demonstrate that NRA is reliable for susceptibility testing of isoniazid and rifampicin, the two most important drugs for the treatment of tuberculosis. In addition, the reduction in the time necessary to obtain susceptibility results is of fundamental importance.

Cited by 13 publications

References 4 publications

Direct drug susceptibility testing of Mycobacterium tuberculosis against primary anti-TB drugs in northern India

Direct drug susceptibility testing of Mycobacterium tuberculosis against primary anti-TB drugs in northern India

Utilidad del ensayo de nitrato reductasa en la detección de Mycobacterium tuberculosis multirresistente en caso de recursos limitados

Evaluation of Nitrate Reductase Assay for Rapid Detection of Drug Resistant Tuberculosis

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