Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications
| Autor: | Bertin C. Bisimwa, Marcel Yotebieng, Freddy M. Birembano, Rosette Nyota, Steven Callens, Esto Bahizire, Andreas H. Diacon, John Z. Metcalfe, Robin M. Warren, Jean B. Nachega, Zacharie Kashongwe, Eric M. Musafiri, André N.H. Bulabula, Jean Paul Chirambiza, Maunank Shah, Patrick D.M.C. Katoto, Grant Theron, Nadia A. Sam-Agudu, Sifa Byadunia, Michel K. Kaswa |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
rpoB mutations Rifampicin resistance Drug resistance Medical and Health Sciences 0302 clinical medicine Tuberculosis Multidrug-Resistant polycyclic compounds heterocyclic compounds 030212 general & internal medicine biology Isoniazid inhA mutations Multidrug-Resistant Biological Sciences Infectious Diseases Democratic Republic of the Congo Population study Rifampin Infection medicine.drug Microbiology (medical) Adult medicine.medical_specialty GenoType MTBDRplus assay Tuberculosis 030106 microbiology Microbial Sensitivity Tests Microbiology Sensitivity and Specificity Mycobacterium tuberculosis Vaccine Related 03 medical and health sciences Rare Diseases Clinical Research Internal medicine Biodefense medicine Humans Online Only Articles drug resistance business.industry Prevention DRC biochemical phenomena metabolism and nutrition medicine.disease biology.organism_classification bacterial infections and mycoses Multiple drug resistance Emerging Infectious Diseases Good Health and Well Being Cross-Sectional Studies Mutation Antimicrobial Resistance business Rifampicin |
| Zdroj: | Clin Infect Dis Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 73, iss 2 |
| Popis: | Background Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting. |
| Databáze: | OpenAIRE |
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