Clinical Impact of the Xpert MTB/RIF Assay in Patients With Multidrug-Resistant Tuberculosis
Clinical Impact of the Xpert MTB/RIF Assay in Patients With Multidrug-Resistant Tuberculosis
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DOI：
10.1097/qai.0000000000001110
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发表时间：
2016-09-01
影响因子：
3.6
通讯作者：
Loveday, Marian
中科院分区：
文献类型：
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作者：
Padayatchi, Nesri;Naidu, Naressa;Loveday, Marian
背景：Xpert MTB/RIF 检测已在南非广泛实施，用于快速结核病 (TB) 筛查。然而，其在管理和改善耐多药结核病 (MDR-TB) 患者治疗结果方面的作用仍不清楚。本研究的目的是评估引入 Xpert MTB/RIF 检测对 MDR-TB 患者的临床影响。方法：我们招募了 921 名 MDR-TB 患者，这些患者在 Xpert MTB/RIF 检测推出和实施之前和之后就诊于南非夸祖鲁-纳塔尔省的一家专业耐药结核病机构。对 2010 年 11 月引入 Xpert MTB/RIF 检测（Xpert 组）后的 108 名耐多药结核病患者的临床、实验室、胸片和随访数据进行了分析，并与 2008 年 7 月至 2010 年 7 月 MTB/RIF 检测前（常规组）的 813 名耐多药结核病患者的数据进行了比较。主要影响衡量标准是 24 个月时的治疗成功率（世界卫生组织的定义）。次要结局是治疗开始时间和疾病发病率。结果：Xpert MTB/RIF 前组和 Xpert MTB/RIF 后组之间的治疗成功率没有显着差异（54% 与 56.5%，P = 0.681）。 Xpert 组开始治疗的中位时间为 20 天（四分位距，13-31），而传统组为 92 天（四分位距，69-120）（P < 0.001）。结论：虽然使用 Xpert MTB/RIF 检测显着缩短了耐多药结核病治疗开始的时间，但对耐多药结核病患者的治疗结果没有显着影响。需要研究 Xpert MTB/RIF 检测方法的使用对耐多药结核病传播的影响。
Background:The Xpert MTB/RIF assay has been widely implemented in South Africa for rapid tuberculosis (TB) screening. However, its usefulness in management and improving treatment outcomes in patients with multidrug-resistant TB (MDR-TB) remains undefined. The aim of this study was to evaluate the clinical impact of introduction of the Xpert MTB/RIF assay in patients with MDR-TB.Methods:We enrolled 921 patients with MDR-TB, who presented to a specialist drug-resistant TB facility in KwaZulu-Natal, South Africa, pre- and post-rollout and implementation of the Xpert MTB/RIF assay. Clinical, laboratory, chest radiograph, and follow-up data from 108 patients with MDR-TB, post-introduction of the Xpert MTB/RIF assay (Xpert group) in November 2010, were analyzed and compared with data from 813 MDR-TB patients from the pre-MTB/RIF assay period (Conventional group), July 2008-2010. Primary impact measure was treatment success (World Health Organization definition) at 24 months. Secondary outcomes were time to treatment initiation and disease morbidity.Results:There were no significant differences in treatment success rates between the pre-Xpert MTB/RIF and post-Xpert MTB/RIF groups (54% versus 56.5%, P = 0.681). Median time to treatment initiation was 20 days (interquartile range, 13-31) in the Xpert group versus 92 days (interquartile range, 69-120) in the Conventional group (P < 0.001).Conclusions:Although use of Xpert MTB/RIF assay significantly reduces the time to initiation of MDR-TB treatment, it had no significant impact on treatment outcomes of patients with MDR-TB. Studies on the impact of the Xpert MTB/RIF assay usage on transmission of MDR-TB are required.