GeneXpert MTB/RIF Testing in the Management of Patients with Active Tuberculosis; A Real Life Experience from Saudi Arabia
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Background: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonaryforms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management ofpatients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact ontime to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. Materials and Methods: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapybetween March 2011 and February 2013 were retrospectively reviewed. Results: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpertMTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterialcultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. Conclusions: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpertMTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculoustherapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosisinvestigations by GeneXpert MTB/RIF warrant further study.
Abstract
Background: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonaryforms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management ofpatients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact ontime to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. Materials and Methods: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapybetween March 2011 and February 2013 were retrospectively reviewed. Results: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpertMTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterialcultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. Conclusions: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpertMTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculoustherapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosisinvestigations by GeneXpert MTB/RIF warrant further study.
참고문헌 (16)
- "Global Tuberculosis Report 2012" (2012)[URL]
- Lonnroth K, "Tuberculosis cont rol and elimination 2010-50: cure, care, and social development", Lan -cet, 375, pp.1814~1829 (2010)
- Mathew P, "Are three sputum acid- fast bacillus smears necessary for discont inuing tuberculosis isolat ion?", J Clin Microbiol, 40, pp.3482~3484 (2002)
- van Kampen SC, "The realistic performan ce achievable with mycobacterial automated culture systems in high and low prevalence settings", BMC Infect Dis, 10, pp.93~ (2010)
- Pai M, "Novel and improved technologies for tuberculosis diagnosis:progress and challenges", Clin Chest Med, 30, pp.701~716 (2009)
- Coll P, "Routine use of Gen-Probe Amplified Mycobacterium tuberculosis Direct (MTD) test for detection of Mycobacterium tuberculosis with smear-positive and smear-n egat ive specimens", Int J Tuberc Lung Dis, 7, pp.886~891 (2003)
- Laraque F, "Performan ce of nucleic acid amplificat ion tests for diagnosis of tuberculosis in a large urban setting", Clin Infect Dis, 49, pp.46~54 (2009)
- Lawn SD, "Xpert( R) MTB", RIF assay: development , evaluat ion and implementat ion of a new rapid molecular diagnostic for tuberculosis and rifam picin resistance, 2011, pp.6, 1067~1082
- "Policy stat ement : automat ed real-t ime nucleic acid am plification technology for rapid and simultan eous detection of tuberculosis and rifam picin resistan ce: Xpert MTB/RIF system" (2011)[URL]
- Boehme CC1, "Rapid molecular detection of tuberculosis and rifam pin resistance", N Eng J Med, 363, pp.1005~1015 (2010)
- Hillemann D1, "Rapid molecular detection of extrapulmonary tuberculosis by the automat ed GeneXpert MTB", RIF system, 2011, pp.49, 1202~1205
- Tortoli E, "Clinical validation of Xpert MTB", RIF for the diagnosis of extrapulmonary tuberculosis, 2012, pp.40, 442~447
- Boehme C1, "Feasibility, diagnostic accuracy, and effectiveness of decent ralised use of the Xpert MTB", RIF test for diagnosis of tuberculosis and multidrug resistan ce:a multicent re implementat ion study, 2011, pp.377, 1495~1505
- Abouzeid MS, "Tuberculosis trend s in Saudis and non- Saudis in the Kingdom of Saudi Arabia - a 10 year retrospective study (2000-2009)", PLoS ONE, 7, pp.e39478~ (2012)
- Al-Ateah SM, "Evaluat ion of direct detection of Mycobacterium tuberculosis complex in respirat ory and non- respirat ory clinical specimens using the Cepheid Gene Xpert( R) system", Saudi Med J, 33, pp.1100~1105 (2012)
- Kranzer, "Improving tuberculosis diagnostics and treatment", Lancet, 377, pp.1467~1468 (2011)