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Utility of second generation line probe assay (Hain MTBDRplus) directly on 2-month sputa specimens to monitor tuberculosis treatment response.

Utility of second generation line probe assay (Hain MTBDRplus) directly on 2-month sputa specimens to monitor tuberculosis treatment response.
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Rockwood N, Wojno J, Ghebrekristos Y, Nicol MP, Meintjes G, Wilkinson RJ,


Rockwood N, Wojno J, Ghebrekristos Y, Nicol MP, Meintjes G, Wilkinson RJ, (click to view)

Rockwood N, Wojno J, Ghebrekristos Y, Nicol MP, Meintjes G, Wilkinson RJ,

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Journal of clinical microbiology 2017 03 01() pii 10.1128/JCM.00025-17

Abstract

The utility of line probe assay (Genotype MTBDRplus) performed directly on 2-month sputa to monitor tuberculosis treatment response is unknown. We assessed if direct testing of 2-month sputa with MTBDRplus can predict 2-month culture conversion and long-term treatment outcome. Xpert® MTB/RIF-confirmed rifampicin-susceptible tuberculosis cases were recruited at tuberculosis diagnosis and followed up at 2 and 5-6 months. MTBDRplus was performed directly on 2-month sputa and on all positive culture isolates at 2 and 5-6 months. We also investigated the association of a positive direct MTBDRplus at 2 months with subsequent unsuccessful tuberculosis treatment outcome (failure/death during treatment or subsequent disease recurrence).279 cases (62% HIV-1 co-infected) were recruited. Direct MTBDRplus at 2 months had a sensitivity of 78%(95%CI 65-87) and specificity of 80%(95%CI 74-84) to predict culture positivity at 2 months with a high negative predictive value of 93%(95%CI 89-96). Inconclusive genotypic susceptibility for both rifampicin and isoniazid were seen in 26% of MTDDRplus tests performed directly on sputum. When compared to a reference of MTBDRplus performed on positive cultures, the false positive resistance rate for direct testing of MTBDRplus on sputa was 4% for rifampicin and 2% for isoniazid. Whilst a positive 2-month smear was not significantly associated with an unsuccessful treatment outcome, (aOR 2.69, 95% CI 0.88-8.21), a positive direct MTBDRplus at 2 months was associated with an unsuccessful outcome (aOR 2.87, 95%CI 1.11-7.42). There is moderate utility of direct 2-month MTBDRplus to predict culture conversion at 2 months and also to predict an unfavorable outcome.

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