Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia
IntroductionTuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.909198/full |
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| author | Anis Karuniawati Erlina Burhan Eko Budi Koendhori Desvita Sari Budi Haryanto Titik Nuryastuti A. A. A. Yuli Gayatri Uleng Bahrun R. Lia Kusumawati Retna Indah Sugiyono Nugroho Harry Susanto Aly Diana Aly Diana Herman Kosasih Adhella Menur Naysilla Dewi Lokida Aaron Neal Sophia Siddiqui Chuen-Yen Lau Muhammad Karyana |
| author_facet | Anis Karuniawati Erlina Burhan Eko Budi Koendhori Desvita Sari Budi Haryanto Titik Nuryastuti A. A. A. Yuli Gayatri Uleng Bahrun R. Lia Kusumawati Retna Indah Sugiyono Nugroho Harry Susanto Aly Diana Aly Diana Herman Kosasih Adhella Menur Naysilla Dewi Lokida Aaron Neal Sophia Siddiqui Chuen-Yen Lau Muhammad Karyana |
| author_sort | Anis Karuniawati |
| collection | DOAJ |
| description | IntroductionTuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions.MethodsWe compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance.ResultsSensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p-value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p-value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST.DiscussionAdditional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT027 58236]. |
| first_indexed | 2024-04-10T21:14:11Z |
| format | Article |
| id | doaj.art-6ab043639ab04d1ab15c505fe193d06b |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-10T21:14:11Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-6ab043639ab04d1ab15c505fe193d06b2023-01-20T12:51:46ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-01-01910.3389/fmed.2022.909198909198Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in IndonesiaAnis Karuniawati0Erlina Burhan1Eko Budi Koendhori2Desvita Sari3Budi Haryanto4Titik Nuryastuti5A. A. A. Yuli Gayatri6Uleng Bahrun7R. Lia Kusumawati8Retna Indah Sugiyono9Nugroho Harry Susanto10Aly Diana11Aly Diana12Herman Kosasih13Adhella Menur Naysilla14Dewi Lokida15Aaron Neal16Sophia Siddiqui17Chuen-Yen Lau18Muhammad Karyana19Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, IndonesiaDepartment of Pulmonary and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, IndonesiaDepartment of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, IndonesiaDepartment of Microbiology, Faculty of Medicine, Universitas Diponegoro, Dr. Kariadi Hospital, Semarang, IndonesiaMicrobiology Unit, Persahabatan Hospital, Jakarta, IndonesiaDepartment of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaDepartment of Internal Medicine, Faculty of Medicine, Universitas Udayana, Prof. IGNG. Ngoerah General Hospital, Bali, IndonesiaDepartment of Clinical Pathology, Faculty of Medicine, University of Hasanuddin, Dr. Wahidin Sudirohusodo Hospital, Makassar, IndonesiaDepartment of Microbiology, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Medan, Indonesia0Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia0Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia0Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia1Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia0Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia0Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia2Department of Clinical Pathology, Tangerang District Hospital, Tangerang, Indonesia3National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States3National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States4HIV Dynamics and Replication Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States5National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, IndonesiaIntroductionTuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions.MethodsWe compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance.ResultsSensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p-value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p-value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST.DiscussionAdditional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT027 58236].https://www.frontiersin.org/articles/10.3389/fmed.2022.909198/fulltuberculosisdiagnosissputum culturesputum microscopyXpert MTB/RIFDST |
| spellingShingle | Anis Karuniawati Erlina Burhan Eko Budi Koendhori Desvita Sari Budi Haryanto Titik Nuryastuti A. A. A. Yuli Gayatri Uleng Bahrun R. Lia Kusumawati Retna Indah Sugiyono Nugroho Harry Susanto Aly Diana Aly Diana Herman Kosasih Adhella Menur Naysilla Dewi Lokida Aaron Neal Sophia Siddiqui Chuen-Yen Lau Muhammad Karyana Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia Frontiers in Medicine tuberculosis diagnosis sputum culture sputum microscopy Xpert MTB/RIF DST |
| title | Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia |
| title_full | Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia |
| title_fullStr | Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia |
| title_full_unstemmed | Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia |
| title_short | Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia |
| title_sort | performance of xpert mtb rif and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in indonesia |
| topic | tuberculosis diagnosis sputum culture sputum microscopy Xpert MTB/RIF DST |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.909198/full |
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