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Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand.
Clin Infect Dis. 2017 May 15; 64(suppl_2):S171-S178.CI

Abstract

BACKGROUND

Delayed diagnosis of tuberculosis (TB) and drug-resistant TB are major challenges of TB control in Thailand. This study assessed the practicality of the Xpert MTB/RIF assay in a real-life setting with high prevalence of human immunodeficiency virus (HIV) infection and pulmonary tuberculosis (PTB).

METHODS

This prospective study was conducted at 3 large tertiary care hospitals. Patients who had suspected PTB were enrolled into the study. Expectorated sputum samples were sent for staining, mycobacterial culture, and Xpert MTB/RIF.

RESULTS

Four hundred ninety-four patients were enrolled. From 355 cases with final diagnosis of PTB, 263 (71.8%) had definite diagnosis and 92 cases had probable diagnosis. Among TB culture-positive cases, Xpert MTB/RIF had 100% and 81% sensitivity in sputum smear-positive and smear-negative groups, respectively. The specificity was 95.7%. The sensitivity and positive predictive value of Xpert MTB/RIF in culture-negative but clinically diagnosed PTB was 37.8% and 83.8%, respectively. Centrifugation was required in 59% cases with scanty sputum. Five cases were false-positive by Xpert MTB/RIF in patients with nontuberculous mycobacteria, old PTB scar, and immune reconstitution syndrome. Discordant rifampicin susceptibility results of Xpert MTB/RIF and mycobacteria growth indicator tube (MGIT) were confirmed by using rpoB gene sequencing, which raised the sensitivity of Xpert MTB/RIF in detecting rifampicin resistance to 93.8%.

CONCLUSIONS

Xpert MTB/RIF is an effective tool in diagnosing PTB but will be more cost-effective for sputum-negative patients and in settings with high prevalence of rifampicin resistance. Early diagnosis of TB results in early treatment and implementation of strategies to limit spreading of TB. Sputum centrifugation may increase the yield of Xpert MTB/RIF.

Authors+Show Affiliations

Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and.Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and.Department of Medicine, Rajavithi Hospital, Bangkok.Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi; and.HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand.HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand.Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and. HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand.Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and. HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28475796

Citation

Kawkitinarong, Kamon, et al. "Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 64, no. suppl_2, 2017, pp. S171-S178.
Kawkitinarong K, Suwanpimolkul G, Kateruttanakul P, et al. Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand. Clin Infect Dis. 2017;64(suppl_2):S171-S178.
Kawkitinarong, K., Suwanpimolkul, G., Kateruttanakul, P., Manosuthi, W., Ubolyam, S., Sophonphan, J., Avihingsanon, A., & Ruxrungtham, K. (2017). Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 64(suppl_2), S171-S178. https://doi.org/10.1093/cid/cix151
Kawkitinarong K, et al. Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand. Clin Infect Dis. 2017 May 15;64(suppl_2):S171-S178. PubMed PMID: 28475796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand. AU - Kawkitinarong,Kamon, AU - Suwanpimolkul,Gompol, AU - Kateruttanakul,Pairaj, AU - Manosuthi,Weerawat, AU - Ubolyam,Sasiwimol, AU - Sophonphan,Jiratchaya, AU - Avihingsanon,Anchalee, AU - Ruxrungtham,Kiat, PY - 2017/5/6/entrez PY - 2017/5/6/pubmed PY - 2018/1/25/medline KW - HIV/TB coinfection KW - mycobacteria growth indicator tube (MGIT) KW - pulmonary tuberculosis KW - rifampicin-resistance tuberculosis. SP - S171 EP - S178 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 64 IS - suppl_2 N2 - BACKGROUND: Delayed diagnosis of tuberculosis (TB) and drug-resistant TB are major challenges of TB control in Thailand. This study assessed the practicality of the Xpert MTB/RIF assay in a real-life setting with high prevalence of human immunodeficiency virus (HIV) infection and pulmonary tuberculosis (PTB). METHODS: This prospective study was conducted at 3 large tertiary care hospitals. Patients who had suspected PTB were enrolled into the study. Expectorated sputum samples were sent for staining, mycobacterial culture, and Xpert MTB/RIF. RESULTS: Four hundred ninety-four patients were enrolled. From 355 cases with final diagnosis of PTB, 263 (71.8%) had definite diagnosis and 92 cases had probable diagnosis. Among TB culture-positive cases, Xpert MTB/RIF had 100% and 81% sensitivity in sputum smear-positive and smear-negative groups, respectively. The specificity was 95.7%. The sensitivity and positive predictive value of Xpert MTB/RIF in culture-negative but clinically diagnosed PTB was 37.8% and 83.8%, respectively. Centrifugation was required in 59% cases with scanty sputum. Five cases were false-positive by Xpert MTB/RIF in patients with nontuberculous mycobacteria, old PTB scar, and immune reconstitution syndrome. Discordant rifampicin susceptibility results of Xpert MTB/RIF and mycobacteria growth indicator tube (MGIT) were confirmed by using rpoB gene sequencing, which raised the sensitivity of Xpert MTB/RIF in detecting rifampicin resistance to 93.8%. CONCLUSIONS: Xpert MTB/RIF is an effective tool in diagnosing PTB but will be more cost-effective for sputum-negative patients and in settings with high prevalence of rifampicin resistance. Early diagnosis of TB results in early treatment and implementation of strategies to limit spreading of TB. Sputum centrifugation may increase the yield of Xpert MTB/RIF. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/28475796/Real_Life_Clinical_Practice_of_Using_the_Xpert_MTB/RIF_Assay_in_Thailand_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cix151 DB - PRIME DP - Unbound Medicine ER -