Performance of Xpert® MTB/RIF in detecting Multidrug-Resistance Tuberculosis in West Java, Indonesia

Edhyana Sahiratmadja, Gde Sindu Mega, Basti Andriyoko, Ida Parwati

Abstract


Indonesia is the 2nd country with the highest tuberculosis (TB) caseload in the world. Inappropriate TB treatment may lead to multidrug-resistance tuberculosis (MDR-TB) development. TB rapid detection is important, and very much needed, to prevent transmission and deaths due to this disease. The Xpert® MTB/RIF is proposed to address this problem. This study aimed to assess the performance of the Xpert® MTB/RIF test in West Java, Indonesia. This was a cross-sectional study conducted on MDR-TB suspects referred to Dr. Hasan Sadikin General Hospital Bandung, West Java, Indonesia, using data from the eTB Manager. The performance of Xpert® MTB/RIF testing and its validity was tested against conventional drug susceptibility testing (DST). In total, data from 4,452 MDR-TB suspects were retrieved but only 578 data that had both DST and Xpert® MTB/RIF results were included in the study. The Xpert® MTB/RIF showed a sensitivity of 88% (95%CI: 85%-91%), specificity of 66% (95%CI: 60%-72%), positive predictive value of 79% (95%CI: 75%-83%), and negative predictive value of 80% (95%CI: 74%-85%), with a detection accuracy of 79%. Xpert® MTB/RIF test in this study shows a good performance for the diagnosis of MDR-TB when compared to the Mycobacterium tuberculosis culture as the gold standard. Therefore, rapid Xpert® MTB/RIF examination is recommended for MDR-TB screening for countries with a high TB burden as a complementary tool to the reference standard test.

 

Performa Xpert® MTB/RIF Dalam Mendeteksi Tuberculosis Resisten Obat di Jawa Barat, Indonesia

Indonesia adalah negara ke-2 dengan jumlah kasus tuberkulosis (TB) tertinggi di dunia. Pengobatan TB yang tidak sesuai dapat mengakibatkan kuman TB menjadi resisten terhadap obat TB yang disebut TB multidrug-resistances (TB-MDR). Untuk itu diperlukan alat deteksi yang mumpuni sehingga kuman TB-DR dapat segera didiagnosis dan diberikan pengobatan yang tepat; dengan demikian pencegahan dan kematian akibat TB dapat ditekan. Penelitian ini bertujuan untuk mengukur performa mesin Xpert® MTB/RIF dalam mendeteksi kuman TB-MDR di Jawa Barat, Indonesia. Studi potong lintang dilakukan dengan mengambil data dari 4452 pasien terduga TB-MDR yang terregistrasi di eTB Manager selama tahun 2012-2016 yang dikirim ke Rumah Sakit Dr. Hasan Sadikin Bandung. Walaupun demikian, hanya 578 yang memiliki hasil test kultur untuk mengetahui sensitivitas obat TB. Dari kedua test tersebut, didapatkan Xpert® MTB/RIF memiliki sensitivitas 88% (95% IK: 85%-91%), spesifisitas 66% (95%CI: 60%-72%), positive predictive value 79% (95% IK: 75%-83%), dan negative predictive value 80% (95% IK: 74%-85%), dengan akurasi 79%. Test TB-MDR menggunakan Xpert® MTB/RIF pada penelitian ini menunjukkan performa yang baik, sehingga test ini sangat direkomendasikan untuk deteksi TB-MDR yang cepat, utamanya di daerah dengan prevalensi TB yang tinggi.


Keywords


MDR-TB; Sensitivity; Specificity; Xpert® MTB/RIF

Full Text:

PDF

References


WHO. Global tuberculosis report 2019. [cited 2019 December 20] Available from: https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1.

Badan Penelitian dan Pengembangan Kesehatan. Riset kesehatan dasar 2013.Available from: https://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf. [cited 2019 December 20].

Kemenkes RI. Direktorat Jendral Pengendalian Penyakit dan Penyehatan Lingkungan. Pedoman nasional pengendalian tuberkulosis. Jakarta: Kemenkes RI; 2014.

Keshavjee S, Farmer PE. Tuberculosis, drug resistance, and the history of modern medicine. N Engl J Med. 2012;367(10):93–6.

Philips JA, Ernst JD. Tuberculosis pathogenesis and immunity. Annu Rev Pathol. 2012;7:353–84.

Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect Dis. 2010;10(9):621–9.

WHO. Xpert MTB/RIF implementation manual. France: WHO; 2014. Available from: https://www.who.int/tb/publications/xpert_implem_manual/en/.

Van Kampen SC, Susanto NH, Simon S, Astiti SD. Effects of introducing Xpert MTB/RIF on diagnosis and treatment of drug-resistant tuberculosis patients in Indonesia : A Pre-Post Intervention Study. PLoS ONE. 2015; 10(6):e0123536.

Afriliyantina RN, Uyaniah A, Yunihastuti E, Karuniawati A, Rumende CM. Kemampuan diagnostik pemeriksaan Xpert MTB/RIF® dengan acuan kultur media cair pada pasien HIV. Ina J CHEST Crit and Emerg Med. 2015; 2(3):188–23.

Chaisson RE, Churchyard GJ. Recurrent tuberculosis: relapse, reinfection, and HIV. J Infect Dis. 2010;201(5):653–5.

Mboowa G, Namaganda C, Ssengooba W. Rifampicin resistance mutations in the 81 bp RRDR of rpoB gene in Mycobacterium tuberculosis clinical isolates using Xpert® MTB/RIF in Kampala, Uganda: a retrospective study. BMC Infect Dis. 2014;14:481.

Ioannidis P, Papaventsis D, Karabela S, Nikolaou S, Panagi M, Raftopoulou E, et al. Cepheid GeneXpert MTB/RIF assay for Mycobacterium tuberculosis detection and rifampin resistance identification in patients with substantial clinical indications of tuberculosis and smear-negative microscopy results. J Clin Microbiol. 2011;49(8):3068–70.

Chang K, Lu W, Wang J, Zhang K, Jia S, Li F, et al. Rapid and effective diagnosis of tuberculosis and rifampicin resistance with Xpert MTB/RIF assay: a meta-analysis. J Infect. 2012;64(6):580–88.

Sharma SK, Kohli M, Yadav RN, Chaubey J. Evaluating the diagnostic accuracy of Xpert MTB/RIF assay in pulmonary tuberculosis PLoS One. 2015;10(10):e0141011.

Zeka AN, Tasbakan S, Cavusoglu C. Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol. 2011;49(12):4138–41.

Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, et al. Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010;363(11):1005–15.

Atashi S, Izadi B, Jalilian S, Madani SH, Farahani A, Mohajeri P. Evaluation of GeneXpert MTB/RIF for determination of rifampicin resistance among new tuberculosis cases in west and northwest Iran. New Microbes New Infect. 2017;19:117–20.

Pang Y, Shang Y, Lu J, Liang Q, Dong L, Li Y, et al. GeneXpert MTB/RIF assay in the diagnosis of urinary tuberculosis from urine specimens. Sci Rep. 2017;7(1):6181.

Talib A, Bhatty S, Mehmood K, Naim H, Haider I, Lal H, et al. GeneXpert in stool: Diagnostic yield in Intestinal Tuberculosis. J Clin Tuberc Other Mycobact Dis. 2019;17:100131.

Saeed M, Iram S, Hussain S, Ahmed A, Akbar M, Aslam M. GeneXpert: A new tool for the rapid detection of rifampicin resistance in mycobacterium tuberculosis. J Pak Med Assoc. 2017;67(2):270–4.




DOI: https://doi.org/10.15395/mkb.v52n2.1966

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.



 

This Journal indexed by

                    

  


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats