The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection.

Antibiotics, Antitubercular / pharmacology Drug Resistance, Bacterial Humans Molecular Diagnostic Techniques / methods Mycobacterium tuberculosis / drug effects Rifampin / pharmacology Sensitivity and Specificity Tuberculosis / diagnosis
HIV Molecular diagnostics Paediatric tuberculosis Pleural tuberculosis Point of care test Rifampicin resistance Tuberculosis Tuberculous meningitis Xpert MTB/RIF Xpert MTB/RIF Ultra

Journal

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420

Informations de publication

Date de publication:
Nov 2019
Historique:
received: 06 12 2018
revised: 14 03 2019
accepted: 16 03 2019
pubmed: 1 4 2019
medline: 6 2 2020
entrez: 1 4 2019
Statut: ppublish

Résumé

Tuberculosis diagnosis has dramatically improved since the introduction of the rapid molecular test Xpert MTB/RIF (Xpert) detecting M. tuberculosis and rifampicin resistance directly from clinical specimens, therefore shortening the turnaround time, reducing patient's isolation period and decreasing the time to start anti-TB drugs. The new version, Xpert MTB/RIF Ultra (Ultra), displays a higher sensitivity and an improved rifampicin resistance detection. Both tests have been endorsed by the World Health Organisation. Xpert and Ultra rapidly became widespread and paved the way for new approaches and new paradigms as well as for the development of molecular point-of-care tests (POCTs). In this narrative review, we aimed to address their performance in the diagnosis of tuberculosis and to discuss the expectations of these tests as well as their limits and the unmet needs. Peer-reviewed publications addressing the diagnostic performance of Ultra and Xpert. We focused on publications that evaluated the performance of Ultra and Xpert on the same group of patients or the same set of specimens in different tuberculosis-burden settings. The studies published so far reported an increased sensitivity of Ultra when compared to Xpert, which represents a benefit for tuberculosis diagnosis. The fact that such a sensitive assay cannot distinguish between alive and dead bacilli emphasizes that caution should be exercised regarding indications and interpretation of results. Additional studies are needed to determine the true performance for the diagnosis of extrapulmonary tuberculosis because of the great diversity of the specimens.

Sections du résumé

BACKGROUND BACKGROUND
Tuberculosis diagnosis has dramatically improved since the introduction of the rapid molecular test Xpert MTB/RIF (Xpert) detecting M. tuberculosis and rifampicin resistance directly from clinical specimens, therefore shortening the turnaround time, reducing patient's isolation period and decreasing the time to start anti-TB drugs. The new version, Xpert MTB/RIF Ultra (Ultra), displays a higher sensitivity and an improved rifampicin resistance detection. Both tests have been endorsed by the World Health Organisation.
AIMS OBJECTIVE
Xpert and Ultra rapidly became widespread and paved the way for new approaches and new paradigms as well as for the development of molecular point-of-care tests (POCTs). In this narrative review, we aimed to address their performance in the diagnosis of tuberculosis and to discuss the expectations of these tests as well as their limits and the unmet needs.
SOURCES METHODS
Peer-reviewed publications addressing the diagnostic performance of Ultra and Xpert.
CONTENT BACKGROUND
We focused on publications that evaluated the performance of Ultra and Xpert on the same group of patients or the same set of specimens in different tuberculosis-burden settings.
IMPLICATIONS CONCLUSIONS
The studies published so far reported an increased sensitivity of Ultra when compared to Xpert, which represents a benefit for tuberculosis diagnosis. The fact that such a sensitive assay cannot distinguish between alive and dead bacilli emphasizes that caution should be exercised regarding indications and interpretation of results. Additional studies are needed to determine the true performance for the diagnosis of extrapulmonary tuberculosis because of the great diversity of the specimens.

Identifiants

DOI: 10.1016/j.cmi.2019.03.021 PMID: 30928564
pubmed: 30928564
pii: S1198-743X(19)30123-5
doi: 10.1016/j.cmi.2019.03.021
pii:
doi:

Substances chimiques

Antibiotics, Antitubercular 0
Rifampin VJT6J7R4TR

Types de publication

Evaluation Study Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1370-1376

Informations de copyright

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

O Opota (O)

Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland. Electronic address: Onya.opota@chuv.ch.

J Mazza-Stalder (J)

Pneumology Service, University Hospital of Lausanne, Lausanne, Switzerland.

G Greub (G)

Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.

K Jaton (K)

Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Antituberculeux › Antibiotiques antituberculeux › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Phénomènes physiologiques › Phénomènes pharmacologiques et toxicologiques › Phénomènes pharmacologiques › Résistance aux substances › Résistance microbienne aux médicaments › Résistance bactérienne aux médicaments › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Techniques d'investigation › Techniques génétiques › Techniques de diagnostic moléculaire › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Bactéries › Bactéries à Gram positif › Bâtonnets à Gram positif › Bâtonnets asporogènes à Gram positif › Bâtonnets asporogènes réguliers à Gram positif › Mycobacteriaceae › Mycobacterium › Mycobacterium tuberculosis › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Composés polycycliques › Composés macrocycliques › Lactames macrocycliques › Rifamycine › Rifampicine › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Sensibilité et spécificité › The rapid molecular test Xpert MTB/RIF ultra:...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Infections bactériennes à Gram positif › Infections à Actinomycetales › Infections à Mycobacterium › Tuberculose › The rapid molecular test Xpert MTB/RIF ultra:...