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Kontsevaya I, Werngren J, Holicka Y, Klaos K, Tran A, Nikolayevskyy V. Non-commercial phenotypic assays for the detection of Mycobacterium tuberculosis drug resistance: a systematic review. Eur J Clin Microbiol Infect Dis 2019; 39:415-426. [PMID: 31667670 DOI: 10.1007/s10096-019-03723-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Several rapid non-commercial culture-based methods and assays for drug susceptibility testing (DST) of Mycobacterium tuberculosis have emerged over the last decades. The aim of the current review was to summarise evidence on the performance of microscopic observation of drug susceptibility (MODS), thin-layer agar (TLA) and colorimetric redox-indicator (CRI) assays for detection of resistance to first- and second-line anti-tuberculosis (TB) drugs. Forty-three publications satisfying selection criteria were selected for data extraction. MODS and CRI assays demonstrated pooled sensitivity and specificity of > 93% for the detection of resistance to rifampicin and isoniazid and confirmed their utility for an accurate detection of multidrug-resistant TB (MDR-TB) in various settings. Sensitivity and specificity values for indirect DST for ethambutol (EMB) using CRI assays were 94.0% and 82.0%, respectively, suggesting that CRIs could be used to rule out resistance to EMB. Performance for other drugs varied more substantially across the reports. There was no sufficient evidence on the performance of the TLA assay for making any conclusion on its utility for DST. Our data suggests that non-commercial assays could be used for a rapid and accurate DST in settings where the use of commercial World Health Organization-endorsed assays could be limited due to a variety of reasons including limited resources, laboratory facilities or trained personnel. While inexpensive and easy-to-perform MODS and TLA assays can be used in low-income settings, using CRI assays for determination of minimal inhibitory concentrations may be implemented in middle- and high-income countries with high MDR-TB burden to guide clinical management of TB patients.
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Affiliation(s)
- Irina Kontsevaya
- Imperial College London, Du Cane Road, London, W12 0NN, UK.,Research Center Borstel, Parkallee 1-40, D-23845, Borstel, Germany
| | - Jim Werngren
- Public Health Agency of Sweden, Nobels väg 18, 17165, Solna, Sweden
| | - Yen Holicka
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Kadri Klaos
- Department of Pulmonary Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.,Department of Mycobacteriology, United Laboratories, Tartu University Hospital, Puusepa 1A, 50406, Tartu, Estonia
| | - Anh Tran
- Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK
| | - Vladyslav Nikolayevskyy
- Imperial College London, Du Cane Road, London, W12 0NN, UK. .,Public Health England, 61 Colindale Ave, London, NW9 5EQ, UK.
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Kwak M, Lee WK, Lim YJ, Lee SH, Ryoo S. Systematic review and meta-analysis of the nitrate reductase assay for drug susceptibility testing of Mycobacterium tuberculosis and the detection limits in liquid medium. J Microbiol Methods 2017; 141:1-9. [PMID: 28694139 DOI: 10.1016/j.mimet.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
Recently, the need for rapid, reliable, and low-cost drug susceptibility testing (DST) methods has increased due to the emergence of multidrug-resistant Mycobacterium tuberculosis. Colorimetric methods of DST provide results more quickly than standard culture methods and are inexpensive than molecular methods. Thus, colorimetric methods, such as the nitrate reductase assay (NRA), are being recommended. We searched Medline PubMed for reports on the NRA for DST of M. tuberculosis written in English and published within the last five years. We selected 20 reports on six major anti-TB drugs and conducted a meta-analysis using Meta-Disc software. The pooled sensitivities for isoniazid, rifampicin, streptomycin, ethambutol, ofloxacin, and kanamycin were 95.4%, 96.4%, 91.5%, 93.1%, 99.3%, and 88.4%, and the pooled specificities were 98.5%, 99.2%, 92.9%, 97.8%, 97.4%, and 99.4%, respectively. The area under the summary receiver operator curve for all drugs was 0.9723-0.9952. The time to results (TTR) for the direct and indirect NRAs was 7-28days and 6-15days, respectively. Quality assessments were conducted using the quality of diagnostic accuracy studies tool (QUADAS-2) items, and most reports showed good performance. However, ethambutol, streptomycin, and kanamycin showed relatively low sensitivity. We performed a quantitative NRA in liquid media at various inoculum concentrations. The TTR at 4.94×106, 1.67×104, and 2.27×102CFU/mL was 4, 14, and 14days, respectively. The minimum absorbance and nitrite concentration for positive samples were 0.8 and 168μM, respectively. We propose a quantitative standard to determine sample positivity to address the problems with the current standard NRA which is much less expensive than the conventional assay conducted on solid medium.
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Affiliation(s)
- Miri Kwak
- Hana Pharmaceutical Pangyo R&D Center, Innovally E-dong, 255, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13550, Republic of Korea
| | - Won-Kyu Lee
- Osong Medical Innovation Foundation, 123 Osongsaengmyeong-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28160, Republic of Korea
| | - Young Ju Lim
- CELLTRION, Academy-ro 51beon-gil, Yeonsu-gu, Incheon 22014, Republic of Korea
| | - Seung Heon Lee
- Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Sungweon Ryoo
- Korean National Tuberculosis Association, 57 Baumoe 6-gil, Seocho-gu 06763, Republic of Korea.
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Catanzaro A, Rodwell TC, Catanzaro DG, Garfein RS, Jackson RL, Seifert M, Georghiou SB, Trollip A, Groessl E, Hillery N, Crudu V, Victor TC, Rodrigues C, Lin GSY, Valafar F, Desmond E, Eisenach K. Performance Comparison of Three Rapid Tests for the Diagnosis of Drug-Resistant Tuberculosis. PLoS One 2015; 10:e0136861. [PMID: 26322781 PMCID: PMC4556461 DOI: 10.1371/journal.pone.0136861] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/10/2015] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this study was to compare the performance of several recently developed assays for the detection of multi- and extensively drug-resistant tuberculosis (M/XDR-TB) in a large, multinational field trial. Methods Samples from 1,128 M/XDR-TB suspects were examined by Line Probe Assay (LPA), Pyrosequencing (PSQ), and Microscopic Observation of Drug Susceptibility (MODS) and compared to the BACTEC MGIT960 reference standard to detect M/XDR-TB directly from patient sputum samples collected at TB clinics in India, Moldova, and South Africa. Results Specificity for all three assays was excellent: 97–100% for isoniazid (INH), rifampin (RIF), moxifloxacin (MOX) and ofloxacin (OFX) and 99–100% for amikacin (AMK), capreomycin (CAP) and kanamycin (KAN) resistance. Sensitivities were lower, but still very good: 94–100% for INH, RIF, MOX and OFX, and 84–90% for AMK and CAP, but only 48–62% for KAN. In terms of agreement, statistically significant differences were only found for detection of RIF (MODS outperformed PSQ) and KAN (MODS outperformed LPA and PSQ) resistance. Mean time-to-result was 1.1 days for LPA and PSQ, 14.3 days for MODS, and 24.7 days for MGIT. Conclusions All three rapid assays evaluated provide clinicians with timely detection of resistance to the drugs tested; with molecular results available one day following laboratory receipt of samples. In particular, the very high specificity seen for detection of drug resistance means that clinicians can use the results of these rapid tests to avoid the use of toxic drugs to which the infecting organism is resistant and develop treatment regiments that have a higher likelihood of yielding a successful outcome.
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Affiliation(s)
- Antonino Catanzaro
- University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Timothy C. Rodwell
- University of California San Diego, La Jolla, California, United States of America
| | | | - Richard S. Garfein
- University of California San Diego, La Jolla, California, United States of America
| | - Roberta L. Jackson
- University of California San Diego, La Jolla, California, United States of America
| | - Marva Seifert
- University of California San Diego, La Jolla, California, United States of America
| | - Sophia B. Georghiou
- University of California San Diego, La Jolla, California, United States of America
| | | | - Erik Groessl
- University of California San Diego, La Jolla, California, United States of America
| | - Naomi Hillery
- University of California San Diego, La Jolla, California, United States of America
| | | | | | | | - Grace Shou-Yean Lin
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, United States of America
| | - Faramarz Valafar
- San Diego State University, San Diego, California, United States of America
| | - Edward Desmond
- Microbial Diseases Laboratory, California Department of Public Health, Richmond, California, United States of America
| | - Kathleen Eisenach
- University of Arkansas, Little Rock, Arkansas, United States of America
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Abstract
The challenge of diagnosing childhood tuberculosis (TB) results from its paucibacillary nature and the difficulties of sputum collection in children. Mycobacterial culture, the diagnostic gold standard, provides microbiological confirmation in only 30% to 40% of childhood pulmonary TB cases and takes up to 6 weeks to result. Conventional drug susceptibility testing requires an additional 2 to 4 weeks after culture confirmation. In response to the low sensitivity and long wait time of the traditional diagnostic approach, many new assays have been developed. These new tools have shortened time to result; however, none of them offer greater sensitivity than culture.
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Affiliation(s)
- Silvia S Chiang
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1150, Houston, TX 77030, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Douglas S Swanson
- Division of Infectious Diseases, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Jeffrey R Starke
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1150, Houston, TX 77030, USA.
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