Diagnostic value of Xpert MTB/RIF Ultra for osteoarticular tuberculosis
Diagnostic value of Xpert MTB/RIF Ultra for osteoarticular tuberculosis
复制标题
Xpert MTB/RIF Ultra 对骨关节结核的诊断价值
DOI：
10.1016/j.jinf.2019.06.006
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发表时间：
2019-08-01
影响因子：
28.2
通讯作者：
Wang, Guirong
中科院分区：
文献类型：
--
作者：
Sun, Qing;Wang, Shuqi;Wang, Guirong
目的：骨关节结核（TB）的诊断仍然具有挑战性，导致诊断不足或过度。本研究旨在评价新型下一代Xpert MTB/RIF Ultra的性能在高负荷环境下，与培养和Xpert MTB/RIF（Xpert）相比，Xpert Ultra（Xpert Ultra）用于骨关节结核诊断的效果。2017年6月至2018年6月在北京胸科医院连续入选骨关节结核疑似病例，并对其脓液标本进行涂片、培养，Xpert和Xpert Ultra。对所有回收的分离株进行了药敏试验（DST）。以复合参考标准（CRS）为金标准，对Xpert Ultra和Xpert的性能进行评价，包括临床、实验室、组织病理学、影像学和≥ 6个月的随访资料。直接头对头性能比较M。结核病检测结果显示，Xpert Ultra（90.91%，120/132）的敏感性高于Xpert（78.79%，104/132，P= 0.006）和培养（39.39%，52/132，P < 0.001）。当整合Xpert Ultra结果时，确诊的骨关节结核病例百分比从84.09%（111/132）增加到93.94%（124/132）。Xpert和Xpert Ultra的特异性分别为100%（34/34）和97.06%（33/34）。Xpert Ultra和Xpert均准确识别了所有9例利福平（RIF）耐药和38例RIF敏感病例（通过表型DST定义）。因此，Xpert Ultra与表型DST检测RIF resistance.Conclusions的一致性为100%：Xpert Ultra检测骨关节结核病例显著多于Xpert或文化，使其成为一个有用的工具，用于快速诊断骨关节结核。(C)2019年英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: The diagnosis of osteoarticular tuberculosis (TB) remains challenging and results in under- or over-diagnosis. The aim of the present study was to evaluate performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to culture and Xpert MTB/RIF (Xpert) for osteoarticular TB diagnosis in high burden settings.Methods: Osteoarticular TB suspected cases were enrolled consecutively during June 2017 to June 2018 at Beijing Chest Hospital and their pus specimens were subjected to smear, culture, Xpert and Xpert Ultra. Drug susceptibility testing (DST) was conducted for all of the recovered isolates. The performances of Xpert Ultra and Xpert were evaluated using composite reference standard (CRS) as gold standard, which included clinical, laboratory, histopathological, radiological and >= 6 months' follow-up data.Results: In total, 186 patients were recruited, and 132 of them were diagnosed with osteoarticular TB according to CRS. The direct head-to-head performance comparison for M. tuberculosis detection showed that Xpert Ultra (90.91%, 120/132) produced a higher sensitivity than Xpert (78.79%, 104/132, P= 0.006) and culture (39.39%, 52/132, P < 0.001). When Xpert Ultra outcomes were integrated, the percentage of confirmed osteoarticular TB case increased from 84.09% (111/132) to 93.94% (124/132). The specificities of Xpert and Xpert Ultra were 100% (34/34) and 97.06% (33/34), respectively. Both Xpert Ultra and Xpert accurately identified all of the 9 rifampicin (RIF)-resistant and 38 RIF-sensitive cases defined by phenotypic DST. Therefore, Xpert Ultra was 100% concordant with phenotypic DST for the detection of RIF resistance.Conclusions: Xpert Ultra detected significantly more osteoarticular TB cases than Xpert or culture, making it a useful tool for rapid diagnosis of osteoarticular TB. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.