Xpert(®) MTB/RIF Detection of Rifampin Resistance and Time to Treatment Initiation in Harare, Zimbabwe

Overview

Journal Int J Tuberc Lung Dis

Specialty Pulmonary Medicine

Date 2016 Jun 12

PMID 27287639

Citations 15

Authors

J Z Metcalfe

S Makumbirofa

B Makamure

C Sandy

W Bara

P Mason

P C Hopewell

Affiliations

Soon will be listed here.

Abstract

Background: Patients at elevated risk of drug-resistant tuberculosis (TB) are prioritized for Xpert(®) MTB/RIF testing; however, the clinical usefulness of the test in this population is understudied.

Design: From November 2011 to June 2014, consecutive out-patients with a history of previous TB in high-density suburbs of Harare, Zimbabwe, were tested using Xpert, solid and liquid culture, and the microscopic observation drug susceptibility assay. Diagnostic accuracy for rifampin (RMP) resistance and time to initiation of second-line regimens were ascertained. The rpoB gene was sequenced in cases with culture-confirmed RMP resistance and genotypic susceptibility.

Results: Among 352 retreatment patients, 71 (20%) were RMP-resistant, 98 (28%) RMP-susceptible, 64 (18%) culture-negative/Xpert-positive, and 119 (34%) culture-negative/Xpert-negative. Xpert had a sensitivity of 86% (95%CI 75-93) and a specificity of 98% (95%CI 92-100) for RMP-resistant TB. The positive predictive value of Xpert-determined RMP resistance for multidrug-resistant TB (MDR-TB) was 82% (95%CI 70-91). Of 71 (83%) participants, 59 initiated treatment with second-line drugs, with a median time to treatment initiation of 18 days (IQR 10-44).

Conclusion: The diagnostic accuracy of Xpert for RMP resistance is high, although the predictive value for MDR-TB was lower than anticipated. Xpert allows for faster initiation of second-line treatment than culture-based drug susceptibility testing under programmatic conditions.

Citing Articles

Pretreatment attrition after rifampicin-resistant tuberculosis diagnosis with Xpert MTB/RIF or ultra in high TB burden countries: a systematic review and meta-analysis.

Jouego C, Decroo T, Netongo P, Gils T BMJ Glob Health. 2025; 10(1).

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High proportion of RR-TB and mutations conferring RR outside of the RRDR of the rpoB gene detected in GeneXpert MTB/RIF assay positive pulmonary tuberculosis cases, in Addis Ababa, Ethiopia.

Akalu G, Tessema B, Petros B PLoS One. 2022; 17(12):e0277145.

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Distribution and frequency of common mutations in gene of detected by Xpert MTB/RIF and identification of residential areas of rifampicin resistant-TB cases: A first retrospective study from Mizoram, Northeast India.

Sailo C, Lalremruata R, Sanga Z, Fela V, Kharkongor F, Chhakchhuak Z J Clin Tuberc Other Mycobact Dis. 2022; 29:100342.

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Impact of the diagnostic test Xpert MTB/RIF on patient outcomes for tuberculosis.

Haraka F, Kakolwa M, Schumacher S, Nathavitharana R, Denkinger C, Gagneux S Cochrane Database Syst Rev. 2021; 5:CD012972.

PMID: 34097769 PMC: 8208889. DOI: 10.1002/14651858.CD012972.pub2.

Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults, irrespective of signs or symptoms.

Shapiro A, Ross J, Yao M, Schiller I, Kohli M, Dendukuri N Cochrane Database Syst Rev. 2021; 3:CD013694.

PMID: 33755189 PMC: 8437892. DOI: 10.1002/14651858.CD013694.pub2.

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