1
|
Ferrer J, Giménez E, Carretero D, Clari MÁ, Orta N, Navarro D, Albert E. Abbott realtime MTB assay for detecting Mycobacterium tuberculosis complex in respiratory specimens: a cost-benefit analysis. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04880-1. [PMID: 38958810 DOI: 10.1007/s10096-024-04880-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Molecular screening for Mycobacterium tuberculosis (MTB) can lead to rapid empirical treatment inception and reduce hospitalization time and complementary diagnostic tests. However, in low-prevalence settings, the cost-benefit balance remains controversial due to the high cost. METHODS We used a Markov model to perform an economic analysis to evaluate the profit after implementing molecular MTB screening (Period B) compared with conventional culture testing (Period A) in respiratory samples from 7,452 consecutive subjects with presumed tuberculosis (TB). RESULTS The proportion of positivity was comparable between both periods (P > 0.05), with a total of 2.16 and 1.78 samples/patient requested in periods A and B, respectively (P < 0.001). The mean length of hospital stay was 8.66 days (95%CI: 7.63-9.70) in Period B and 11.51 days (95%CI: 10.15-12.87) in Period A (P = 0.001). The healthcare costs associated with diagnosing patients with presumed TB were reduced by €717.95 per patient with PCR screening. The probability of remaining hospitalized and the need for a greater number of outpatient specialty care visits were the variables with the most weight in the model. CONCLUSION Employing PCR as an MTB screening method in a low-prevalence setting may increase the profits to the system.
Collapse
Affiliation(s)
- Josep Ferrer
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Estela Giménez
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Diego Carretero
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Mª Ángeles Clari
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Nieves Orta
- Microbiology Unit, Hospital Francisco de Borja, Gandía, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Spain, Av. Blasco Ibáñez 17, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.
- Department of Microbiology, School of Medicine, University of Valencia, Spain, Av. Blasco Ibáñez 17, Valencia, Spain.
| |
Collapse
|
2
|
Parwati I, Chaidir L, Yunus M, Montain MM, Budhiarko D, Selasih SF, Ristandi RB, Rachman RW, Nurhayati RD, Pambudi I, Budiyati AD. Evaluation of a real-time PCR assay performance to detect Mycobacterium tuberculosis, rifampicin, and isoniazid resistance in sputum specimens: a multicenter study in two major cities of Indonesia. Front Microbiol 2024; 15:1372647. [PMID: 38800757 PMCID: PMC11123600 DOI: 10.3389/fmicb.2024.1372647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
Background Tuberculosis (TB) is one of the major global health issues due to its high mortality rate, especially in low- and middle-income countries. One of the key success points of the TB eradication program is early TB diagnosis, which requires rapid and accurate diagnostic testing. This study aimed to evaluate the performance of a newly developed RT-PCR kit (Indigen MTB/DR-TB RT-PCR) in a routine TB clinical setting. Method A multi-fluorescence RT-PCR assay was designed and developed to detect regions within IS6110, rpoB, katG, and inhA of the Mycobacterium tuberculosis (MTB) genes. Sputum specimens were obtained from suspected TB patients who visited TB healthcare facilities in two major cities of Indonesia from September 2022 to May 2023. Specimens were assessed using Indigen MTB/DR-TB RT-PCR, acid-fast bacillus (AFB) smear microscopy, MTB culture, and drug susceptibility testing (DST) methods. Fisher's exact test (χ2) was used to analyze the Indigen performance relative to culture methods. Result The performance of Indigen MTB/DR-TB RT-PCR to detect MTB was assessed using 610 sputum specimens obtained from suspected patients. The overall sensitivity and specificity were 94.12% (95% CI: 90.86-96.48%) and 98.32% (95% CI: 96.20-99.46%), respectively. When the analysis was performed on AFB smear-negative TB subjects (386 subjects), a lower sensitivity level was found at 78.57% (95% CI: 68.26-86.78%), while the specificity level remained similar at 98.34% (95% CI: 96.18-99.46%). The overall performance of Indigen MTB/DR-TB RT-PCR to detect MTB showed substantial agreement with the MTB culture method (kappa value 0.93). In comparison to DST, the sensitivity and specificity levels of Indigen to detect RIF resistance or INH resistance were 78.2% (95% CI: 61.8-90.2%) and 82.8% (95% CI: 64.2-94.2%), respectively, while the specificity level for both groups was at 100% (95% CI, 87.7-100%). Conclusion Indigen MTB/DR-TB RT-PCR demonstrated reliable performance for TB molecular diagnostic testing and can be implemented in routine TB diagnostic settings.
Collapse
Affiliation(s)
- Ida Parwati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Lidya Chaidir
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Muhammad Yunus
- Stem Cell and Cancer Institute, PT. Kalbe Farma, Jakarta, Indonesia
| | - Maya Marinda Montain
- Unit Pelayanan Fungsional Balai Besar Kesehatan Paru Masyarakat Bandung (UPF BBKPM), Bandung, Indonesia
| | - Dini Budhiarko
- Stem Cell and Cancer Institute, PT. Kalbe Farma, Jakarta, Indonesia
| | | | | | | | | | - Imran Pambudi
- Directorate General of Diseases Prevention and Control, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | | |
Collapse
|
3
|
Yang X, Fan S, Ma Y, Chen H, Xu JF, Pi J, Wang W, Chen G. Current progress of functional nanobiosensors for potential tuberculosis diagnosis: The novel way for TB control? Front Bioeng Biotechnol 2022; 10:1036678. [PMID: 36588948 PMCID: PMC9798010 DOI: 10.3389/fbioe.2022.1036678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB), induced by the foxy Mycobacterium tuberculosis (Mtb), is still one of the top killers worldwide among infectious diseases. Although several antibiotics have been developed to significantly relieve the tuberculosis epidemics worldwide, there are still several important scientific challenges for tuberculosis. As one of the most critical issues for tuberculosis control, the accurate and timely diagnosis of tuberculosis is critical for the following therapy of tuberculosis and thus responsible for the effective control of drug-resistant tuberculosis. Current tuberculosis diagnostic methods in clinic are still facing the difficulties that they can't provide the rapid diagnostic results with high sensitivity and accuracy, which therefore requires the development of more effective novel diagnostic strategies. In recent decades, nanomaterials have been proved to show promising potentials for novel nanobiosensor construction based on their outstanding physical, chemical and biological properties. Taking these promising advantages, nanomaterial-based biosensors show the potential to allow the rapid, sensitive and accurate tuberculosis diagnosis. Here, aiming to increase the development of more effective tuberculosis diagnostic strategy, we summarized the current progress of nanobiosensors for potential tuberculosis diagnosis application. We discussed the different kind diagnostic targets for tuberculosis diagnosis based on nanobiosensors, ranging from the detection of bacterial components from M. tuberculosis, such as DNA and proteins, to the host immunological responses, such as specific cytokine production, and to the direct whole cell detection of M. tuberculosis. We believe that this review would enhance our understandings of nanobiosensors for potential tuberculosis diagnosis, and further promote the future research on nanobiosensor-based tuberculosis diagnosis to benefit the more effective control of tuberculosis epidemic.
Collapse
Affiliation(s)
- Xuran Yang
- Department of Clinical Medicine Laboratory, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Shuhao Fan
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China,Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan, China
| | - Yuhe Ma
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China,Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan, China
| | - Hui Chen
- Department of Clinical Medicine Laboratory, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Jun-Fa Xu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China,Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan, China
| | - Jiang Pi
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China,Institute of Laboratory Medicine, School of Medical Technology, Guangdong Medical University, Dongguan, China,*Correspondence: Jiang Pi, ; Wandang Wang, ; Guanghui Chen,
| | - Wandang Wang
- Department of Clinical Medicine Laboratory, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China,*Correspondence: Jiang Pi, ; Wandang Wang, ; Guanghui Chen,
| | - Guanghui Chen
- Department of Clinical Medicine Laboratory, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China,*Correspondence: Jiang Pi, ; Wandang Wang, ; Guanghui Chen,
| |
Collapse
|
4
|
WITHDRAWN: Analysis of the application value of molecular diagnostic technology of mycobacterium tuberculosis. J Clin Tuberc Other Mycobact Dis 2022. [DOI: 10.1016/j.jctube.2022.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
5
|
Wu C, Ma Y, Chen L. A low-fouling and reusable biosensor for the sensitive electrochemical assay of tuberculosis gene. J Electroanal Chem (Lausanne) 2022. [DOI: 10.1016/j.jelechem.2022.116013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Huang J, Xiao Z, Yang X, Chen X, Wang X, Chen Y, Zheng W, Chen W, Chen H, Li S. Two target genes based multiple cross displacement amplification combined with a lateral flow biosensor for the detection of Mycobacterium tuberculosis complex. BMC Microbiol 2021; 21:267. [PMID: 34607556 PMCID: PMC8491432 DOI: 10.1186/s12866-021-02328-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is a serious chronic infectious disease caused by Mycobacterium tuberculosis complex (MTBC). Hence, the development of a novel, simple, rapid and sensitive method to detect MTBC is of great significance for the prevention and treatment of TB. Results In this study, multiple cross displacement amplification (MCDA) combined with a nanoparticle-based lateral flow biosensor (LFB) was developed to simultaneously detect two target genes (IS6110 and mpb64) of MTBC (MCDA-LFB). One suite of specific MCDA primers designed for the IS6110 and mpb64 genes was validated using genomic DNA extracted from the reference strain H37Rv. The MCDA amplicons were analyzed using a real-time turbidimeter, colorimetric indicator (malachite green, MG) and LFBs. The optimal amplification temperature and time were confirmed, and the MCDA-LFB method established in the current report was evaluated by detecting various pathogens (i.e., reference strains, isolates and clinical sputum samples). The results showed that the two sets of MCDA primers targeting the IS6110 and mpb64 genes could effectively detect MTBC strains. The optimal reaction conditions for the MCDA assay were determined to be 67 °C for 35 min. The MCDA assay limit of detection (LoD) was 100 fg per reaction for pure genomic DNA. The specificity of the MCDA-LFB assay was 100%, and there were no cross-reactions for non-MTBC strains. For sputum samples and MTBC strain detection, the positive rate of MCDA-LFB for the detection of MTBC strains was consistent with seminested automatic real-time PCR (Xpert MTB/RIF) and higher than acid-fast staining (AFS) and culture assays when used for sputum samples. The MCDA-LFB assay was a rapid tool, and the whole procedure for MCDA-LFB, including DNA template preparation, MCDA reaction and amplification product analysis, was completed within 70 min. Conclusion The MCDA-LFB assay targeting the IS6110 and mpb64 genes is a simple, rapid, sensitive and reliable detection method, and it has potential significance for the prevention and treatment of TB.
Collapse
Affiliation(s)
- Junfei Huang
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China
| | - Ziyu Xiao
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China.,Public Health School, Guizhou Medical University, Guiyang, 550025, Guizhou, People's Republic of China
| | - Xinggui Yang
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China.,Public Health School, Guizhou Medical University, Guiyang, 550025, Guizhou, People's Republic of China
| | - Xu Chen
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, 550003, People's Republic of China
| | - Xiaojuan Wang
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China.,Public Health School, Guizhou Medical University, Guiyang, 550025, Guizhou, People's Republic of China
| | - Yijiang Chen
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China
| | - Wenlin Zheng
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China
| | - Wei Chen
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China
| | - Huijuan Chen
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China
| | - Shijun Li
- Laboratory of Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, 73 Bageyan Road, Guiyang, 550004, Guizhou, People's Republic of China. .,Public Health School, Guizhou Medical University, Guiyang, 550025, Guizhou, People's Republic of China.
| |
Collapse
|
7
|
Kohli M, MacLean E, Pai M, Schumacher SG, Denkinger CM. Diagnostic accuracy of centralised assays for TB detection and detection of resistance to rifampicin and isoniazid: a systematic review and meta-analysis. Eur Respir J 2021; 57:13993003.00747-2020. [PMID: 32855226 DOI: 10.1183/13993003.00747-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/30/2020] [Indexed: 11/05/2022]
Abstract
Various diagnostic companies have developed high throughput molecular assays for tuberculosis (TB) and resistance detection for rifampicin and isoniazid. We performed a systematic review and meta-analyses to assess the diagnostic accuracy of five of these tests for pulmonary specimens. The tests included were Abbott RealTime MTB, Abbott RealTime RIF/INH, FluoroType MTB, FluoroType MTDBR and BD Max MDR-TB assay.A comprehensive search of six databases for relevant citations was performed. Cross-sectional, case-control, cohort studies, and randomised controlled trials of any of the index tests were included. Respiratory specimens (such as sputum, bronchoalveolar lavage, tracheal aspirate, etc) or their culture isolates.A total of 21 included studies contributed 26 datasets. We could only meta-analyse data for three of the five assays identified, as data were limited for the remaining two. For TB detection, the included assays had a sensitivity of 91% or more and the specificity ranged from 97% to 100%. For rifampicin resistance detection, all the included assays had a sensitivity of more than 92%, with a specificity of 99-100%. Sensitivity for isoniazid resistance detection varied from 70 to 91%, with higher specificity of 99-100% across all index tests. Studies that included head-to-head comparisons of these assays with Xpert MTB/RIF for detection of TB and rifampicin resistance suggested comparable diagnostic accuracy.In people with symptoms of pulmonary TB, the centralised molecular assays demonstrate comparable diagnostic accuracy for detection of TB, rifampicin and isoniazid resistance to Xpert MTB/RIF assay, a WHO recommended molecular test.
Collapse
Affiliation(s)
- Mikashmi Kohli
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Emily MacLean
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Madhukar Pai
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Samuel G Schumacher
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,S.G. Schumacher and C.M. Denkinger are joint senior authors
| | - Claudia M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland.,Centre for Infectious Diseases, University Heidelberg, Heidelberg, Germany.,S.G. Schumacher and C.M. Denkinger are joint senior authors
| |
Collapse
|
8
|
Borrás R, Martínez V, Vinuesa V, Torres I, Orta N, Clari MÁ, Prat J, Navarro D. Field performance of the Abbott RealTime MTB assay for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. Enferm Infecc Microbiol Clin 2019; 38:206-211. [PMID: 31668859 DOI: 10.1016/j.eimc.2019.08.007] [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: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The sensitivities of conventional mycobacterial culture in solid or liquid media and acid-fast bacilli (AFB) smear microscopy for Mycobacterium tuberculosis complex (MTBC) detection in extrapulmonary specimens are suboptimal. We evaluated the field performance of the Abbott RealTime MTB assay for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. METHODS The total number of extrapulmonary specimens with mycobacterial culture and PCR results was 566: sterile fluids (n=278), non-sterile fluids (n=147), lymph node material (n=69) tissue biopsies (n=63), and abscess aspirates (n=9). A composite standard consisting of mycobacterial culture results, clinical treatment response to anti-TB drugs, when administered, and histopathology, radiological and laboratory findings were used as a reference for sensitivity and specificity calculations. RESULTS Mycobacterial cultures and PCR were positive in 17 and 28 specimens, respectively. The overall agreement between culture and PCR was moderate (Cohen's kappa coefficient: 0.549; P=0.0001). Taking as a reference our composite standard, the sensitivity of the Abbott PCR assay was 77.7%, the specificity 99.5%, the PPV 95.4%, and the NPV 98.8%. In turn, the sensitivity of the mycobacterial culture was 62.9%, the specificity and PPV 100%, and the NPV 97.9%. CONCLUSION The good field performance of the Abbott RealTime MTB assay makes it valuable for the diagnosis of extrapulmonary tuberculosis in a low-prevalence setting. The use of molecular methods along with culture improves the diagnosis of extrapulmonary tuberculosis.
Collapse
Affiliation(s)
- Rafael Borrás
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain; Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Víctor Martínez
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Víctor Vinuesa
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Ignacio Torres
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Nieves Orta
- Microbiology Unit, Hospital Francisco de Borja, Gandía, Spain
| | | | - Josep Prat
- Microbiology Unit, Hospital de Sagunto, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, Valencia, Spain; Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain.
| |
Collapse
|