RESUMO
The purpose of this study was to assess the performance of Cepheid® Xpert MTB/RIF® ("Xpert") and TB-Biochip® MDR ("TB-Biochip"). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein-Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube® (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0-98.3 %] than direct (59.6 %, 95 % CI, 50.2-68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7-91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4-87.5 %); the specificity was 86.0 % (95 % CI, 78.9-91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5-99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8-99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0-99.5 %); the specificity was 78.1 % (95 % CI, 61.5-89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2-100 %) of RIF-R, 94.7 % (95 % CI, 76.7-99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4-99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1-94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods.
Assuntos
Técnicas Bacteriológicas , Testes de Sensibilidade Microbiana , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Adulto , Técnicas Bacteriológicas/métodos , Humanos , Testes de Sensibilidade Microbiana/métodos , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Reprodutibilidade dos Testes , Federação Russa/epidemiologia , Sensibilidade e Especificidade , Escarro/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
SETTING: Joint World Health Organization (WHO) projects in Vladimir and Orel regions, Russia. OBJECTIVE: To study the prevalence of extensively drug-resistant (XDR) tuberculosis (TB). METHODS: Drug susceptibility testing of second-line drugs (ofloxacin, kanamycin, capreomycin, ethionamide, cycloserine and para-aminosalicylic acid) was performed on isolates from multidrug-resistant TB cases from 1 January to 31 December 2006. RESULTS: In Orel, 16 (21.3%) of 75 tested isolates were XDR-TB; in Vladimir, 9 (4.9%) of 182 isolates were XDR-TB. Bilateral lung involvement was significantly associated with XDR-TB (prevalence ratio = 2.61, 95%CI 1.01-6.72). CONCLUSION: XDR-TB has emerged in Russia. It is crucial to prevent, diagnose and treat TB and MDR-TB more effectively.