Treatment outcomes, diagnostic and therapeutic impact: Xpert vs. smear. A systematic review and meta-analysis.
Journal
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
ISSN: 1815-7920
Titre abrégé: Int J Tuberc Lung Dis
Pays: France
ID NLM: 9706389
Informations de publication
Date de publication:
01 01 2019
01 01 2019
Historique:
entrez:
25
1
2019
pubmed:
25
1
2019
medline:
21
12
2019
Statut:
ppublish
Résumé
Compared with smear microscopy, Xpert Citations (2000-2016) reporting treatment outcomes of patients diagnosed using Xpert compared with smear were selected from PubMed, Scopus and conference abstracts. We conducted a systematic review and meta-analysis. Favorable (cured, completed) and unfavorable (failure, death, loss to follow-up) outcomes were pooled for meta-analysis; we also reviewed the number of TB cases diagnosed, time to treatment and empiric treatment. The Mantel-Haenszel method with a fixed-effect model was used; From 13 citations, 43 594 TB patients were included and 4825 were with known TB treatment outcome. From the pooled analysis, an unfavorable outcomes among those diagnosed using Xpert compared with smear was 20.2%, 541/2675 vs. 21.9%, 470/2150 (risk ratio 0.92, 95%CI 0.82-1.02). Statistical heterogeneity was low ( Xpert implementation showed no discernible impact on treatment outcomes compared with conventional smear despite reduced time to diagnosis, time to treatment or reduced level of empiric treatment. Further research is required to learn more about gaps in the existing health system.
Sections du résumé
BACKGROUND
Compared with smear microscopy, Xpert
METHODS
Citations (2000-2016) reporting treatment outcomes of patients diagnosed using Xpert compared with smear were selected from PubMed, Scopus and conference abstracts. We conducted a systematic review and meta-analysis. Favorable (cured, completed) and unfavorable (failure, death, loss to follow-up) outcomes were pooled for meta-analysis; we also reviewed the number of TB cases diagnosed, time to treatment and empiric treatment. The Mantel-Haenszel method with a fixed-effect model was used;
RESULTS
From 13 citations, 43 594 TB patients were included and 4825 were with known TB treatment outcome. From the pooled analysis, an unfavorable outcomes among those diagnosed using Xpert compared with smear was 20.2%, 541/2675 vs. 21.9%, 470/2150 (risk ratio 0.92, 95%CI 0.82-1.02). Statistical heterogeneity was low (
CONCLUSIONS
Xpert implementation showed no discernible impact on treatment outcomes compared with conventional smear despite reduced time to diagnosis, time to treatment or reduced level of empiric treatment. Further research is required to learn more about gaps in the existing health system.
Identifiants
pubmed: 30674379
doi: 10.5588/ijtld.18.0203
pmc: PMC6872902
mid: NIHMS1059466
doi:
Substances chimiques
Antibiotics, Antitubercular
0
Types de publication
Journal Article
Meta-Analysis
Research Support, U.S. Gov't, P.H.S.
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
82-92Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Organisme : PEPFAR
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Références
J Clin Microbiol. 2010 Jan;48(1):229-37
pubmed: 19864480
Cochrane Database Syst Rev. 2014 Jan 21;(1):CD009593
pubmed: 24448973
PLoS One. 2016 Mar 08;11(3):e0151073
pubmed: 26954678
J Clin Microbiol. 2010 Oct;48(10):3551-7
pubmed: 20720033
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Trans R Soc Trop Med Hyg. 2016 Aug;110(8):432-44
pubmed: 27638038
Int J Tuberc Lung Dis. 2015 May;19(5):545-51
pubmed: 25868022
AIDS. 2015 Sep 24;29(15):1987-2002
pubmed: 26266773
J Clin Epidemiol. 1992 Mar;45(3):255-65
pubmed: 1569422
Lancet Infect Dis. 2015 Jan;15(1):17-8
pubmed: 25541165
Lancet Respir Med. 2015 Aug;3(8):621-30
pubmed: 26208996
PLoS Med. 2014 Nov 25;11(11):e1001760
pubmed: 25423041
Public Health Rep. 2007 Sep-Oct;122(5):683-92
pubmed: 17877317
PLoS Med. 2014 Dec 09;11(12):e1001766
pubmed: 25490549
Acta Orthop. 2007 Oct;78(5):598-609
pubmed: 17966018
Open Forum Infect Dis. 2014 Jun 25;1(1):ofu038
pubmed: 25734106
Lancet. 2014 Feb 1;383(9915):424-35
pubmed: 24176144
J Infect Dis. 2007 Aug 15;196 Suppl 1:S76-85
pubmed: 17624829
Lancet Infect Dis. 2014 Jun;14(6):527-32
pubmed: 24438820
Lancet. 2011 Apr 30;377(9776):1495-505
pubmed: 21507477
PLoS One. 2017 Jul 7;12(7):e0180572
pubmed: 28686705
PLoS One. 2015 Apr 27;10(4):e0123252
pubmed: 25915745
Int J Tuberc Lung Dis. 2015 Apr;19(4):392-8
pubmed: 25859993
PLoS One. 2012;7(11):e48599
pubmed: 23139799
Lancet Glob Health. 2015 Aug;3(8):e450-e457
pubmed: 26187490
Am J Respir Crit Care Med. 2008 Apr 1;177(7):680-5
pubmed: 18202347
PLoS One. 2015 May 21;10(5):e0126065
pubmed: 25996389
Pan Afr Med J. 2015 Mar 16;20:247
pubmed: 26161170