Assessing the utility of Xpert(®) MTB/RIF as a screening tool for patients admitted to medical wards in South Africa.
Assessing the utility of Xpert(®) MTB/RIF as a screening tool for patients admitted to medical wards in South Africa.
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DOI：
10.1038/srep19391
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发表时间：
2016-01-20
影响因子：
4.6
通讯作者：
Wilson D
中科院分区：
文献类型：
--
作者：
Heidebrecht CL;Podewils LJ;Pym AS;Cohen T;Mthiyane T;Wilson D
南非许多住院病人患有未确诊的活动性和耐药结核病（TB）。早期发现结核病对于通知立即采取感染控制行动以尽量减少传播风险至关重要。我们评估了Xpert®MTB/RIF （GeneXpert）作为南非一家大型公立医院住院筛查工具的效用。纳入2013年3月至6月期间连续入住病房的成年患者；收集痰标本，通过GeneXpert、涂片镜检和培养进行检测。对所有入院患者进行胸部x光检查（CXRs）作为标准护理。我们评估了通过每种诊断方法确诊为结核病的患者比例。在出院后可查阅病历的入组患者中，61例（27%）被诊断为结核病；34例（占结核确诊病例的56%）为GeneXpert阳性。当排除通过其他方法确诊为结核病的患者时，GeneXpert仅发现了4例额外的结核病病例。然而，GeneXpert在一名患者中发现了利福平耐药结核病，该患者最初是根据CXR诊断的。在常规开展CXR并服务于结核病和结核/艾滋病毒合并感染高度流行的人群的机构中，GeneXpert用于结核病筛查的效用有限，但它允许快速检测利福平耐药性。
Many hospital inpatients in South Africa have undiagnosed active and drug-resistant tuberculosis (TB). Early detection of TB is essential to inform immediate infection control actions to minimize transmission risk. We assessed the utility of Xpert® MTB/RIF (GeneXpert) as a screening tool for medical admissions at a large public hospital in South Africa. Consecutive adult patients admitted to medical wards between March-June 2013 were enrolled; sputum specimens were collected and tested by GeneXpert, smear microscopy, and culture. Chest X-rays (CXRs) were conducted as standard care for all patients admitted. We evaluated the proportion of patients identified with TB disease through each diagnostic method. Among enrolled patients whose medical charts were available for review post-discharge, 61 (27%) were diagnosed with TB; 34 (56% of diagnosed TB cases) were GeneXpert positive. When patients in whom TB was identified by other means were excluded, GeneXpert yielded only four additional TB cases. However, GeneXpert identified rifampicin-resistant TB in one patient, who was initially diagnosed based on CXR. The utility of GeneXpert for TB screening was limited in an institution where CXR is conducted routinely and which serves a population in which TB and TB/HIV co-infection are highly prevalent, but it allowed for rapid detection of rifampicin resistance.