Direct nitrate reductase assay versus microscopic observation drug susceptibility test for rapid detection of MDR-TB in Uganda.
Direct nitrate reductase assay versus microscopic observation drug susceptibility test for rapid detection of MDR-TB in Uganda.
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DOI：
10.1371/journal.pone.0019565
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发表时间：
2011-05-09
期刊：
影响因子：
3.7
通讯作者：
Hoffner S
中科院分区：
文献类型：
--
作者：
Bwanga F;Haile M;Joloba ML;Ochom E;Hoffner S
在资源有限的环境中，检测耐药结核病最常用的方法是在洛温斯坦-詹森培养基上进行间接药敏试验，这种方法非常耗时，要在2-3个月后才能获得结果。因此，耐多药结核病的有效治疗明显延迟，患者可传播耐药菌株。因此，在耐药结核病的诊断中非常需要适用于rls的快速和准确的检测。在这项研究中，我们比较了两种直接技术-硝酸盐还原酶测定（NRA）和显微镜观察药物敏感性（MODS）在高负担RLS中快速检测耐多药结核病。研究了可解释结果的敏感性、特异性和比例。从乌干达坎帕拉一家结核病诊所连续接受再治疗的245名结核病患者中收集了涂片阳性痰。样品在国家标准实验室处理，采用直接NRA法、直接MODS法和间接LJ比例法进行利福平和异烟肼药敏试验。共有229份标本被确认为结核分枝杆菌，其中217份（95%）的结果可由NRA或MODS解释。NRA诊断耐多药结核病的敏感性、特异性和kappa一致性分别为97%、98%和0.93；MODS分别为87%、95%和0.78。NRA、MODS和参比技术的中位时间分别为10、7和64天。对于快速检测，每个样品的实验室用品成本很低，约为5美元。与参考方法相比，直接NRA和MODS可快速检测出耐药性，时间几乎提前了8周。在研究环境中，直接NRA具有高度的敏感性和特异性。我们认为它有很大的潜力可以及时发现RLS中的耐多药结核病。
The most common method for detection of drug resistant (DR) TB in resource-limited settings (RLSs) is indirect susceptibility testing on Lowenstein-Jensen medium (LJ) which is very time consuming with results available only after 2–3 months. Effective therapy of DR TB is therefore markedly delayed and patients can transmit resistant strains. Rapid and accurate tests suitable for RLSs in the diagnosis of DR TB are thus highly needed. In this study we compared two direct techniques - Nitrate Reductase Assay (NRA) and Microscopic Observation Drug Susceptibility (MODS) for rapid detection of MDR-TB in a high burden RLS. The sensitivity, specificity, and proportion of interpretable results were studied. Smear positive sputum was collected from 245 consecutive re-treatment TB patients attending a TB clinic in Kampala, Uganda. Samples were processed at the national reference laboratory and tested for susceptibility to rifampicin and isoniazid with direct NRA, direct MODS and the indirect LJ proportion method as reference. A total of 229 specimens were confirmed as M. tuberculosis, of these interpretable results were obtained in 217 (95%) with either the NRA or MODS. Sensitivity, specificity and kappa agreement for MDR-TB diagnosis was 97%, 98% and 0.93 with the NRA; and 87%, 95% and 0.78 with the MODS, respectively. The median time to results was 10, 7 and 64 days with NRA, MODS and the reference technique, respectively. The cost of laboratory supplies per sample was low, around 5 USD, for the rapid tests. The direct NRA and MODS offered rapid detection of resistance almost eight weeks earlier than with the reference method. In the study settings, the direct NRA was highly sensitive and specific. We consider it to have a strong potential for timely detection of MDR-TB in RLS.
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影响因子：
9.4
作者：
Angeby, KAK;Klintz, L;Hoffner, SE
通讯作者：
Hoffner, SE
DOI：
10.3791/845
发表时间：
2008-08-11
期刊：
Journal of visualized experiments : JoVE
影响因子：
--
作者：
Brady, Mark F;Coronel, Jorge;Moore, David Aj
通讯作者：
Moore, David Aj
影响因子：
3.7
作者：
Albert H;Bwanga F;Mukkada S;Nyesiga B;Ademun JP;Lukyamuzi G;Haile M;Hoffner S;Joloba M;O'Brien R
通讯作者：
O'Brien R
影响因子：
9.4
作者：
Affolabi, Dissou;Odoun, Mathieu;Portaels, Francoise
通讯作者：
Portaels, Francoise
影响因子：
3.1
作者：
Carley, S;Dosman, S;Harrison, M
通讯作者：
Harrison, M