객담 검체에서 다제내성 결핵균의 검출을 위한 GenoType® MTBDRplus의 평가
Evaluation of the Performance of GenoType® MTBDRplus Assay for Rapid Detection of Multi-drug Resistant Mycobacterium tuberculosis in Sputum Specimens
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Background: GenoType^® MTBDRplus assay (Hain Lifescience, Germany) enables detection of the mutations prevalent in rpoB, katG, and inhA genes and identification of Mycobacterium tuberculosis complex (MTB). We evaluated the performance of the MTBDRplus assay in detecting multidrug resistant M. tuberculosis in sputum specimens by directly comparing it to the performance of conventional drug susceptibility testing (DST) with M. tuberculosis culture isolates. Methods: From December 2007 to July 2008, 40 patients with acid-fast bacilli (AFB) smear-positive and AFB culture-positive sputa, including 19patients with rifampin (RIF)- or isoniazid (INH)-resistant MTB isolates, were enrolled. The MTBDRplus assay was performed using DNA extracted from respiratory specimens. DST of the culture isolates was performed using an absolute concentration method. Results: The result of the AFB smear test was ±1 for 7 specimens, +1 for 8 specimens, +2 for 9 specimens, +3 for 9 specimens, and +4 for 7 specimens. The MTBDRplus assay revealed that 37 of the 40 specimens were positive for an MTB-specific band, 12 specimens were RIF-resistant,and 16 specimens were INH-resistant. The rpoB S531L mutation was detected in 58.3% of the RIF-resistant specimens, and the katG S315T1and inhA C15T mutations were detected in 56.3% and 31.3% of the INH-resistant specimens, respectively. Compared to the sensitivity and specificity of DST, both sensitivity and specificity of MTBDRplus assay for RIF resistance were 100%, and the corresponding values for INH resistance were 82.4% and 90.0%. Discrepant MTBDRplus assay and DST results were obtained in 3 INH-resistant isolates without mutation and 2 INHsusceptible isolates with katG S315T1 and inhA C15T mutations. Conclusions: The MTBDRplus assay can be applied for AFB smear-positive specimens with positivity ± to 4+. The assay was reliable for predicting the RIF resistance of culture isolates, but DST was required for confirming INH resistance.
Abstract
Background: GenoType^® MTBDRplus assay (Hain Lifescience, Germany) enables detection of the mutations prevalent in rpoB, katG, and inhA genes and identification of Mycobacterium tuberculosis complex (MTB). We evaluated the performance of the MTBDRplus assay in detecting multidrug resistant M. tuberculosis in sputum specimens by directly comparing it to the performance of conventional drug susceptibility testing (DST) with M. tuberculosis culture isolates. Methods: From December 2007 to July 2008, 40 patients with acid-fast bacilli (AFB) smear-positive and AFB culture-positive sputa, including 19patients with rifampin (RIF)- or isoniazid (INH)-resistant MTB isolates, were enrolled. The MTBDRplus assay was performed using DNA extracted from respiratory specimens. DST of the culture isolates was performed using an absolute concentration method. Results: The result of the AFB smear test was ±1 for 7 specimens, +1 for 8 specimens, +2 for 9 specimens, +3 for 9 specimens, and +4 for 7 specimens. The MTBDRplus assay revealed that 37 of the 40 specimens were positive for an MTB-specific band, 12 specimens were RIF-resistant,and 16 specimens were INH-resistant. The rpoB S531L mutation was detected in 58.3% of the RIF-resistant specimens, and the katG S315T1and inhA C15T mutations were detected in 56.3% and 31.3% of the INH-resistant specimens, respectively. Compared to the sensitivity and specificity of DST, both sensitivity and specificity of MTBDRplus assay for RIF resistance were 100%, and the corresponding values for INH resistance were 82.4% and 90.0%. Discrepant MTBDRplus assay and DST results were obtained in 3 INH-resistant isolates without mutation and 2 INHsusceptible isolates with katG S315T1 and inhA C15T mutations. Conclusions: The MTBDRplus assay can be applied for AFB smear-positive specimens with positivity ± to 4+. The assay was reliable for predicting the RIF resistance of culture isolates, but DST was required for confirming INH resistance.
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