Performance of Cepheid® Xpert MTB/RIF® and TB-Biochip® MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis

摘要

The purpose of this study was to assess the performance of Cepheid® Xpert MTB/RIF® (“Xpert”) and TB-Biochip® MDR (“TB-Biochip”). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein–Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube® (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0–98.3 %] than direct (59.6 %, 95 % CI, 50.2–68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7–91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4–87.5 %); the specificity was 86.0 % (95 % CI, 78.9–91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5–99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8–99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0–99.5 %); the specificity was 78.1 % (95 % CI, 61.5–89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2–100 %) of RIF-R, 94.7 % (95 % CI, 76.7–99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4–99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1–94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods.