Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China
Abstract Background Xpert MTB/RIF (Xpert) is an automated molecular test recommended by World Health Organization (WHO) for diagnosis of tuberculosis (TB). This study evaluated the effect of Xpert implementation on the detection of pulmonary TB (PTB) and rifampicin-resistant TB (RR-TB) cases in Shan...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-020-4871-9 |
| _version_ | 1823929347391619072 |
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| author | Zheyuan Wu Zulma Vanessa Rueda Tao Li Zurong Zhang Yuan Jiang Wei Sha Fangyou Yu Jing Chen Qichao Pan Xin Shen Zheng’an Yuan |
| author_facet | Zheyuan Wu Zulma Vanessa Rueda Tao Li Zurong Zhang Yuan Jiang Wei Sha Fangyou Yu Jing Chen Qichao Pan Xin Shen Zheng’an Yuan |
| author_sort | Zheyuan Wu |
| collection | DOAJ |
| description | Abstract Background Xpert MTB/RIF (Xpert) is an automated molecular test recommended by World Health Organization (WHO) for diagnosis of tuberculosis (TB). This study evaluated the effect of Xpert implementation on the detection of pulmonary TB (PTB) and rifampicin-resistant TB (RR-TB) cases in Shanghai, China. Methods Xpert was routinely implemented in 2018 for all presumptive PTB patients. All PTB patients above 15 years-old identified within the Provincial TB Control Program during the first half of each of 2017 and 2018, were enrolled to compare the difference in proportions of bacteriological confirmation, patients with drug susceptibility test (DST) results for rifampicin (ie, DST coverage) and RR-TB detection before and after Xpert’s implementation. Results A total of 6047 PTB patients were included in the analysis with 1691 tested by Xpert in 2018. Percentages of bacteriological confirmation, DST coverage and RR-TB detection in 2017 and 2018 were 50% vs. 59%, 36% vs. 49% and 2% vs. 3%, respectively (all p-values < 0.05). Among 1103 PTB patients who completed sputum smear, culture and Xpert testing in 2018, Xpert detected an additional 121 (11%) PTB patients who were negative by smear and culture, but missed 248 (23%) smear and/or culture positive patients. Besides, it accounted for an increase of 9% in DST coverage and 1% in RR-TB detection. The median time from first visit to a TB hospital to RR-TB detection was 62 days (interquartile range -IQR 48–84.2) in 2017 vs. 9 days (IQR 2–45.7) in 2018 (p-value < 0.001). In the multivariate model, using Xpert was associated with decreased time to RR-TB detection (adjusted hazard ratio = 4.62, 95% confidence interval: 3.18–6.71). Conclusions Integrating Xpert with smear, culture and culture-based DST in a routine setting significantly increased bacteriological confirmation, DST coverage and RR-TB detection with a dramatic reduction in the time to RR-TB diagnosis in Shanghai, China. Our findings can be useful for other regions that attempt to integrate Xpert into routine PTB and RR-TB case-finding cascade. Further study should focus on the identification and elimination of operational level challenges to fully utilize the benefit of rapid diagnosis by Xpert. |
| first_indexed | 2024-12-16T21:08:08Z |
| format | Article |
| id | doaj.art-ceaf14b7919849249ceaf524f7181461 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-16T21:08:08Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-ceaf14b7919849249ceaf524f71814612022-12-21T22:16:16ZengBMCBMC Infectious Diseases1471-23342020-02-0120111010.1186/s12879-020-4871-9Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, ChinaZheyuan Wu0Zulma Vanessa Rueda1Tao Li2Zurong Zhang3Yuan Jiang4Wei Sha5Fangyou Yu6Jing Chen7Qichao Pan8Xin Shen9Zheng’an Yuan10Department of Tuberculosis Control, Shanghai Municiple Center for Disease Control and PreventionUniversidad Pontificia BolivarianaChinese Center for Disease Control and PreventionDepartment of Tuberculosis Control, Shanghai Municiple Center for Disease Control and PreventionLaboratory of Tuberculosis Diagnosis, Shanghai Municiple Center for Disease Control and PreventionShanghai Key Laboratory of Tuberculosis, Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of MedicineDepartment of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of MedicineDepartment of Tuberculosis Control, Shanghai Municiple Center for Disease Control and PreventionShanghai Municiple Center for Disease Control and PreventionDepartment of Tuberculosis Control, Shanghai Municiple Center for Disease Control and PreventionShanghai Municiple Center for Disease Control and PreventionAbstract Background Xpert MTB/RIF (Xpert) is an automated molecular test recommended by World Health Organization (WHO) for diagnosis of tuberculosis (TB). This study evaluated the effect of Xpert implementation on the detection of pulmonary TB (PTB) and rifampicin-resistant TB (RR-TB) cases in Shanghai, China. Methods Xpert was routinely implemented in 2018 for all presumptive PTB patients. All PTB patients above 15 years-old identified within the Provincial TB Control Program during the first half of each of 2017 and 2018, were enrolled to compare the difference in proportions of bacteriological confirmation, patients with drug susceptibility test (DST) results for rifampicin (ie, DST coverage) and RR-TB detection before and after Xpert’s implementation. Results A total of 6047 PTB patients were included in the analysis with 1691 tested by Xpert in 2018. Percentages of bacteriological confirmation, DST coverage and RR-TB detection in 2017 and 2018 were 50% vs. 59%, 36% vs. 49% and 2% vs. 3%, respectively (all p-values < 0.05). Among 1103 PTB patients who completed sputum smear, culture and Xpert testing in 2018, Xpert detected an additional 121 (11%) PTB patients who were negative by smear and culture, but missed 248 (23%) smear and/or culture positive patients. Besides, it accounted for an increase of 9% in DST coverage and 1% in RR-TB detection. The median time from first visit to a TB hospital to RR-TB detection was 62 days (interquartile range -IQR 48–84.2) in 2017 vs. 9 days (IQR 2–45.7) in 2018 (p-value < 0.001). In the multivariate model, using Xpert was associated with decreased time to RR-TB detection (adjusted hazard ratio = 4.62, 95% confidence interval: 3.18–6.71). Conclusions Integrating Xpert with smear, culture and culture-based DST in a routine setting significantly increased bacteriological confirmation, DST coverage and RR-TB detection with a dramatic reduction in the time to RR-TB diagnosis in Shanghai, China. Our findings can be useful for other regions that attempt to integrate Xpert into routine PTB and RR-TB case-finding cascade. Further study should focus on the identification and elimination of operational level challenges to fully utilize the benefit of rapid diagnosis by Xpert.http://link.springer.com/article/10.1186/s12879-020-4871-9SORT ITXpert MTB/RIFTBDelayRifampicin resistantTuberculosis |
| spellingShingle | Zheyuan Wu Zulma Vanessa Rueda Tao Li Zurong Zhang Yuan Jiang Wei Sha Fangyou Yu Jing Chen Qichao Pan Xin Shen Zheng’an Yuan Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China BMC Infectious Diseases SORT IT Xpert MTB/RIF TB Delay Rifampicin resistant Tuberculosis |
| title | Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China |
| title_full | Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China |
| title_fullStr | Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China |
| title_full_unstemmed | Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China |
| title_short | Effect of the Xpert MTB/RIF on the detection of pulmonary tuberculosis cases and rifampicin resistance in Shanghai, China |
| title_sort | effect of the xpert mtb rif on the detection of pulmonary tuberculosis cases and rifampicin resistance in shanghai china |
| topic | SORT IT Xpert MTB/RIF TB Delay Rifampicin resistant Tuberculosis |
| url | http://link.springer.com/article/10.1186/s12879-020-4871-9 |
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