Added value of molecular assay Xpert MTB/RIF compared to sputum smear microscopy to assess the risk of tuberculosis transmission in a low-prevalence country.

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State: Public
Version: Final published version
Serval ID
serval:BIB_8C3FAFE42703
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Added value of molecular assay Xpert MTB/RIF compared to sputum smear microscopy to assess the risk of tuberculosis transmission in a low-prevalence country.
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Author(s)
Opota O., Senn L., Prod'hom G., Mazza-Stalder J., Tissot F., Greub G., Jaton K.
ISSN
1469-0691 (Electronic)
ISSN-L
1198-743X
Publication state
Published
Issued date
07/2016
Peer-reviewed
Oui
Volume
22
Number
7
Pages
613-619
Language
english
Notes
Publication types: Comparative Study ; Evaluation Studies ; Journal Article
Publication Status: ppublish
Abstract
Airborne precautions are required at hospital admission for patients with suspected pulmonary tuberculosis. The isolation is maintained until 3 serially collected sputum smears are acid-fast bacilli negative, a time- and labor-intensive method with limited sensitivity and specificity, which has a great impact on patient flow management. We evaluated the possibility of replacing the result of microscopy by the semiquantitative result of the molecular point-of-care test Xpert MTB/RIF to assess patients' transmission risk to quickly guide airborne isolation decisions in low-endemic countries. The performance of the Xpert MTB/RIF, used as a first-line test, was compared to the results of microscopy for specimens (n=242) collected from May 2010 to December 2014 in Lausanne, Switzerland. The sensitivity and specificity of Xpert MTB/RIF were 91.5% (65/71) and 99.6% (170/171), respectively, vs. 64.8% (46/71) and 94.2% (161/171) for microscopy. Samples with negative Xpert MTB/RIF were all smear negative for Mycobacterium tuberculosis (negative predictive value, 100%). The semiquantitative results of Xpert MTB/RIF-high, medium, low or very low-were found to correlate with acid-fast bacilli detection: positive predictive value of 100% (6/6), 96.5% (27/28), 52.2% (12/23) and 11.1% (1/9) respectively. Finally, when including clinical criteria, we identified 11 smear-negative but Xpert MTB/RIF-positive patients with a significant transmission potential. In conclusion, our data support the introduction of an Xpert MTB/RIF-based strategy as a replacement of smear microscopy for a faster and more accurate management of tuberculosis patients' transmission risk in a low-prevalence country.

Keywords
Adult, Female, Humans, Male, Microscopy/methods, Middle Aged, Molecular Diagnostic Techniques/methods, Mycobacterium tuberculosis/cytology, Mycobacterium tuberculosis/genetics, Mycobacterium tuberculosis/isolation & purification, Point-of-Care Systems, Predictive Value of Tests, Sensitivity and Specificity, Sputum/microbiology, Switzerland, Tuberculosis, Pulmonary/diagnosis, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
17/05/2016 17:49
Last modification date
20/08/2019 14:50
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