Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting

a Scottish Perspective

Benjamin J. Parcell, Anna Jarchow MacDonald, Louise Seagar, Ian Laurenson, Gordon J. Prescott, Michael Lockhart

Research output: Contribution to journalArticle

5 Citations (Scopus)
4 Downloads (Pure)

Abstract

Objectives
Xpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture.

Methods
Xpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance.

Results
A total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected.

Conclusions
Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy.
Original languageEnglish
Pages (from-to)466-472
Number of pages7
JournalJournal of Infection
Volume74
Issue number5
Early online date22 Feb 2017
DOIs
Publication statusPublished - 5 May 2017

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Benzophenoneidum
Microscopy
Tuberculosis
Rifampin
Pulmonary Tuberculosis
Isoniazid
Infection Control
Real-Time Polymerase Chain Reaction
Genotype

Keywords

  • Xpert MTB/RIF
  • Mycobacterium tuberculosis
  • tuberculosis
  • molecular testing
  • early diagnosis
  • nucleic acid amplification

Cite this

Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting : a Scottish Perspective. / Parcell, Benjamin J.; Jarchow MacDonald, Anna; Seagar, Louise; Laurenson, Ian; Prescott, Gordon J.; Lockhart, Michael.

In: Journal of Infection, Vol. 74, No. 5, 05.05.2017, p. 466-472.

Research output: Contribution to journalArticle

Parcell, Benjamin J. ; Jarchow MacDonald, Anna ; Seagar, Louise ; Laurenson, Ian ; Prescott, Gordon J. ; Lockhart, Michael. / Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting : a Scottish Perspective. In: Journal of Infection. 2017 ; Vol. 74, No. 5. pp. 466-472.
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abstract = "ObjectivesXpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture.MethodsXpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance.ResultsA total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8{\%}, specificity 99.5{\%}, positive predictive value (PPV) 82.1{\%}, and negative predictive value (NPV) 99.9{\%}. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected.ConclusionsXpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy.",
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AU - Seagar, Louise

AU - Laurenson, Ian

AU - Prescott, Gordon J.

AU - Lockhart, Michael

N1 - We would like to thank all the laboratory staff who took part in this study and Tracey Adam, Microbiology Office Supervisor, for assistance in collection of results.

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N2 - ObjectivesXpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture.MethodsXpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance.ResultsA total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected.ConclusionsXpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy.

AB - ObjectivesXpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture.MethodsXpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance.ResultsA total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected.ConclusionsXpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy.

KW - Xpert MTB/RIF

KW - Mycobacterium tuberculosis

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KW - early diagnosis

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