Xpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implications

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dc.contributor.authorBisimwa, Bertin C.en_ZA
dc.contributor.authorNachega, Jean B.en_ZA
dc.contributor.authorWarren, Robin M.en_ZA
dc.contributor.authorTheron, Granten_ZA
dc.contributor.authorMetcalfe, John Z.en_ZA
dc.contributor.authorShah, Maunanken_ZA
dc.contributor.authorDiacon, Andreas H.en_ZA
dc.contributor.authorSam-Agudu, Nadia A.en_ZA
dc.contributor.authorYotebieng, Marcelen_ZA
dc.contributor.authorBulabula, André N. H.en_ZA
dc.contributor.authorKatoto, Patrick D. M. C.en_ZA
dc.contributor.authorChirambiza, Jean-Paulen_ZA
dc.contributor.authorNyota, Rosetteen_ZA
dc.contributor.authorBirembano, Freddy M.en_ZA
dc.contributor.authorMusafiri, Eric M.en_ZA
dc.contributor.authorByadunia, Sifaen_ZA
dc.contributor.authorBahizire, Estoen_ZA
dc.contributor.authorKaswa, Michel K.en_ZA
dc.contributor.authorCallens, Stevenen_ZA
dc.contributor.authorKashongwe, Zacharie M.en_ZA
dc.date.accessioned2022-06-07T14:27:28Zen_ZA
dc.date.available2022-06-07T14:27:28Zen_ZA
dc.date.issued2020-06en_ZA
dc.descriptionCITATION: Bisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873en_ZA
dc.descriptionThe original publication is available at https://academic.oup.com/cid/en_ZA
dc.description.abstractBackground Rifampicin (RIF) resistance is highly correlated with isoniazid (INH) resistance and used as proxy for multidrug-resistant tuberculosis (MDR-TB). Using MTBDRplus as a comparator, we evaluated the predictive value of Xpert MTB/RIF (Xpert)–detected RIF resistance for MDR-TB in eastern Democratic Republic of the Congo (DRC). Methods We conducted a cross-sectional study involving data from new or retreatment pulmonary adult TB cases evaluated between July 2013 and December 2016. Separate, paired sputa for smear microscopy and MTBDRplus were collected. Xpert testing was performed subject to the availability of Xpert cartridges on sample remnants after microscopy. Results Among 353 patients, 193 (54.7%) were previously treated and 224 (63.5%) were MTBDRplus TB positive. Of the 224, 43 (19.2%) were RIF monoresistant, 11 (4.9%) were INH monoresistant, 53 (23.7%) had MDR-TB, and 117 (52.2%) were RIF and INH susceptible. Overall, among the 96 samples detected by MTBDRplus as RIF resistant, 53 (55.2%) had MDR-TB. Xpert testing was performed in 179 (50.7%) specimens; among these, 163 (91.1%) were TB positive and 73 (44.8%) RIF resistant. Only 45/73 (61.6%) Xpert-identified RIF-resistant isolates had concomitant MTBDRplus-detected INH resistance. Xpert had a sensitivity of 100.0% (95% CI, 92.1–100.0) for detecting RIF resistance but a positive-predictive value of only 61.6% (95% CI, 49.5–72.8) for MDR-TB. The most frequent mutations associated with RIF and INH resistance were S531L and S315T1, respectively. Conclusions In this high-risk MDR-TB study population, Xpert had low positive-predictive value for the presence of MDR-TB. Comprehensive resistance testing for both INH and RIF should be performed in this setting.en_ZA
dc.description.urihttps://academic.oup.com/cid/article/73/2/e362/5863452?login=trueen_ZA
dc.description.versionPublishers versionen_ZA
dc.format.extent9 pagesen_ZA
dc.identifier.citationBisimwa, B. C. et al. 2020. Xpert Mycobacterium tuberculosis/Rifampicin–Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clinical Infectious Diseases, 73(2):e362–e370. doi:10.1093/cid/ciaa873en_ZA
dc.identifier.issn1537-6591 (online)en_ZA
dc.identifier.issn1058-4838 (print)en_ZA
dc.identifier.otherdoi:10.1093/cid/ciaa873en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/125339en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherOxford University Pressen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectMultidrug-resistant tuberculosisen_ZA
dc.subjectDrug resistanceen_ZA
dc.subjectRifampinen_ZA
dc.subjectIsoniaziden_ZA
dc.subjectTuberculosis -- Diagnosisen_ZA
dc.titleXpert mycobacterium tuberculosis/rifampicin-detected rifampicin resistance is a suboptimal surrogate for multidrug-resistant tuberculosis in Eastern Democratic Republic of the Congo : diagnostic and clinical implicationsen_ZA
dc.typeArticleen_ZA
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