Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia

作者：Anis Karuniawati, Erlina Burhan, Eko Budi Koendhori, Desvita Sari, Budi Haryanto, Titik Nuryastuti, A. A. A. Yuli Gayatri, Uleng Bahrun, R. Lia Kusumawati, Retna Indah Sugiyono, Nugroho Harry Susanto, Aly Diana, Herman Kosasih, Adhella Menur Naysilla, Dewi Lokida, Aaron Neal, Sophia Siddiqui, Chuen‐Yen Lau, Muhammad Karyana · 发表于：Frontiers in Medicine · 年份：2023 · DOI：10.3389/fmed.2022.909198 · 被引用次数：19 · 研究领域：Tuberculosis Research and Epidemiology、Image Processing Techniques and Applications、Medical Research and Islamic Perspectives

Introduction Tuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions. Methods We compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance. Results Sensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p -value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p -value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonar...