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AutorLuetkemeyer, Anne F.
AutorFirnhaber, Cynthia
AutorKendall, Michelle A.
AutorWu, Xingye
AutorMazurek, Gerald H.
AutorBenator, Debra A.
AutorArduino, Roberto
AutorFernandez, Michel
AutorGuy, Elizabeth
AutorJohnson, Pamela
AutorMetchock, Beverly
AutorSattler, Fred
AutorTelzak, Edward
AutorWang, Yun F.
AutorWeiner, Marc
AutorSwindells, Susan
AutorSanne, Ian M.
AutorHavlir, Diane V.
AutorGrinsztejn, Beatriz
AutorAlland, David
Fecha de acceso2018-10-08T18:25:56Z
Fecha de disponibilización2018-10-08T18:25:56Z
Fecha de publicación2016
ReferenciaLUETKEMEYER, Anne. F. et al. Evaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settings. Clinical Infectious Diseases, v. 62, n. 9, p. 1081–1088, May 2016.pt_BR
ISSN1058-4838pt_BR
URIhttps://www.arca.fiocruz.br/handle/icict/29439
DescripciónAIDS Clinical Trials Group A5295 and Tuberculosis Trials Consortium Study 34 Teams.
PromociónThis work was supported by the National Institute of Allergy and Infectious Diseases through the ACTG (grant numbers AI068634, U01AI068636, and UM1 AI106701); the CDC through the TBTC and the Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention; the National Institute of Mental Health, and the National Institute of Dental and Craniofacial Research.
Idiomaengpt_BR
EditorOxford
Derechos de autoropen accesspt_BR
TítuloEvaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settingspt_BR
Tipo del documentoArticlept_BR
DOI10.1093/cid/ciw035
Resumen en InglésBackground: The Xpert MTB/RIF (Xpert) assay is a rapid nucleic acid amplification test widely used in settings of high tuberculosis prevalence to detect tuberculosis as well asrpoBmutations associated with rifampin resistance. Data are needed on the diagnostic performance of Xpert in lower-prevalence settings to inform appropriate use for both tuberculosis detection and the need for respiratory isolation. Methods: Xpert was compared to 2 sputum samples, each evaluated with acid-fast bacilli (AFB) smear and mycobacterial culture using liquid and solid culture media, from participants with suspected pulmonary tuberculosis from the United States, Brazil, and South Africa. Results: Of 992 participants enrolled with evaluable results, 22% had culture-confirmed tuberculosis. In 638 (64%) US participants, 1 Xpert result demonstrated sensitivity of 85.2% (96.7% in participants with AFB smear-positive [AFB(+)] sputum, 59.3% with AFB smear-negative [AFB(-)] sputum), specificity of 99.2%, negative predictive value (NPV) of 97.6%, and positive predictive value of 94.9%. Results did not differ between higher- and low-prevalence settings. A second Xpert assay increased overall sensitivity to 91.1% (100% if AFB(+), 71.4% if AFB(-)), with specificity of 98.9%. In US participants, a single negative Xpert result predicted the absence of AFB(+)/culture-positive tuberculosis with an NPV of 99.7%; NPV of 2 Xpert assays was 100%, suggesting a role in removing patients from airborne infection isolation. Xpert detected tuberculosis DNA and mutations associated with rifampin resistance in 5 of 7 participants with rifampin-resistant, culture-positive tuberculosis. Specificity for rifampin resistance was 99.5% and NPV was 98.9%. Conclusions: In the United States, Xpert testing performed comparably to 2 higher-tuberculosis-prevalence settings. These data support the use of Xpert in the initial evaluation of tuberculosis suspects and in algorithms assessing need for respiratory isolation. Keywords: HIV/tuberculosis coinfection; Xpert MTB/RIF; nontuberculous mycobacteria; respiratory isolation; tuberculosis diagnosis.pt_BR
AfiliaciónDivision of HIV, Infectious Diseases and Global Medicine. San Francisco General Hospital. University of California. USA.pt_BR
AfiliaciónClinical HIV Research Unit Department of Internal Medicine. Faculty of Health Sciences. University of the Witwatersrand Right to Care. Johannesburg, South Africa.pt_BR
AfiliaciónCenter for Biostatistics in AIDS Research. Harvard T.H. Chan School of Public Health. Boston, Massachusetts.pt_BR
AfiliaciónCenter for Biostatistics in AIDS Research. Harvard T.H. Chan School of Public Health. Boston, Massachusetts.pt_BR
AfiliaciónDivision of Tuberculosis Elimination. Centers for Disease Control and Prevention. Atlanta, Georgia.pt_BR
AfiliaciónInfectious Diseases Section. Veterans Affairs Medical Center and The George Washington University. Washington, DC, USA.pt_BR
AfiliaciónDepartment of Internal Medicine. Division of Infectious Diseases. The University of Texas Health Science Center at Houston. Houston, USA.pt_BR
AfiliaciónUniversity of North Texas Health Science Center. Tarrant County Health Department. Fort Worth, USA.pt_BR
AfiliaciónSection of Pulmonary Critical Care and Sleep Medicine. Baylor College of Medicine. Ben Taub General Hospital. Houston, Texas, USA.pt_BR
AfiliaciónCepheid. Sunnyvale.pt_BR
AfiliaciónDivision of Tuberculosis Elimination. Centers for Disease Control and Prevention. Atlanta, Georgia, USA.pt_BR
AfiliaciónDivision of Infectious Diseases. Keck School of Medicine of USC. Los Angeles, California, USA.pt_BR
AfiliaciónSt. Barnabus Hospital Health System. Albert Einstein College of Medicine. Bronx, New York, USA.pt_BR
AfiliaciónEmory University School of Medicine. Grady Memorial Hospital. Atlanta, Georgia, USA.pt_BR
AfiliaciónDepartment of Medicine. University of Texas Health Science Center. Veterans Administration Medical Center. San Antonio, USA.pt_BR
AfiliaciónInternal Medicine/Infectious Diseases. University of Nebraska Medical Center. Lincoln, USA.pt_BR
AfiliaciónRight to Care. Johannesburg, South Africa Department of Internal Medicine. Faculty of Health Sciences. University of the Witwatersrand. Johannesburg, South Africa.pt_BR
AfiliaciónDivision of HIV. Infectious Diseases and Global Medicine. San Francisco General Hospital. University of California. USA.pt_BR
AfiliaciónFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.pt_BR
AfiliaciónDivision of Infectious Disease. Rutgers New Jersey Medical School. Newark, USA.pt_BR
Palavras clave en InglêsXpert MTB/RIFpt_BR
Palavras clave en InglêsTuberculosis diagnosispt_BR
Palavras clave en InglêsRespiratory isolationpt_BR
Palavras clave en InglêsNontuberculous mycobacteriapt_BR
Palavras clave en InglêsHIV/tuberculosis coinfectionpt_BR
e-ISSN1537-6591


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