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Performance of Xpert MTB/RIF for the Diagnosis of Extrapulmonary Tuberculosis

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Abstract
Background: Mycobacterial burden is low in extrapulmonary specimens, making diagnosis and treatment difficult. Xpert MTB/RIF is a real-time PCR assay for the detection of Mycobacterium tuberculosis and rifampin resistance. This study evaluated the performance of the Xpert MTB/RIF assay in extrapulmonary specimens.

Methods: Acid-Fast Bacilli (AFB) smear, culture, and Xpert MTB/RIF were performed on extrapulmonary specimens. Mycobacterial culture was performed on BACTEC MGIT liquid for 6 weeks and 2% Ogawa medium for 8 weeks. Overall sensitivity and specificity of Xpert MTB/RIF was estimated using culture as a gold standard. Xpert MTB/RIF sensitivity and cycle-threshold (Ct) values according to AFB smear grade were evaluated. The sensitivity, specificity, and concordance of rifampin resistance compared to the phenotypic drug sensitivity test were evaluated.

Results: A total of 1,289 specimens were included in the study. The overall sensitivity and specificity of the Xpert MTB/RIF assay were 59.4% (41/69, 95% CI 46.9 - 70.9%) and 99.3% (1,212/1,220, 95% CI 98.7 - 99.7), respectively. Positive predictive value of Xpert MTB/RIF was 83.7% (41/49, 95% CI 69.8 - 92.2) and negative predictive value was 97.7% (1,212/1,240, 95% CI 96.7 - 98.5%). Xpert MTB/RIF assay sensitivity significantly increased with increases in AFB smear grade (p < 0.001). AFB smear grades and Xpert MTB/RIF Ct values were negatively correlated. Rifampin resistance results of Xpert MTB/RIF and culture showed a concordance rate of 97.2%.

Conclusions: The Xpert MTB/RIF assay could be used to replace the AFB smear for the diagnosis of extrapulmonary tuberculosis, and has high specificity for the detection of rifampin resistance.
Author(s)
김수경장정현최상호성흥섭김미나
Issued Date
2021
Type
Article
Keyword
AntibioticsAntitubercular* / pharmacologyAntibioticsAntitubercular* / therapeutic useDrug ResistanceBacterialHumansMycobacterium tuberculosis* / geneticsRifampin / pharmacologySensitivity and SpecificitySputumTuberculosis* / diagnosisTuberculosis* / drug therapy
DOI
10.7754/Clin.Lab.2020.200423
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8572
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_crossref_primary_10_7754_Clin_Lab_2020_200423&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Performance%20of%20Xpert%20MTB%2FRIF%20for%20the%20Diagnosis%20of%20Extrapulmonary%20Tuberculosis&amp;offset=0&amp;pcAvailability=true
Publisher
CLINICAL LABORATORY
Location
독일
Language
한국어
ISSN
1433-6510
Citation Volume
67
Citation Number
2
Citation Start Page
229
Citation End Page
234
Appears in Collections:
Medicine > Medicine
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