A Systematic Review on the Effectiveness of Detection of M. tuberculosis and Rifampin Resistance Using Xpert MTB/RIF

Ji-Young Jeong; Seon-Heui Lee; Sunyoung Jang

doi:10.5145/ACM.2014.17.2.42

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Jeong, Lee, and Jang: A Systematic Review on the Effectiveness of Detection of M. tuberculosis and Rifampin Resistance Using Xpert MTB/RIF

Original Article

Ann Clin Microbiol 2014;17(2):42-49.

Published online: 5 June 2014

DOI: https://doi.org/10.5145/ACM.2014.17.2.42

A Systematic Review on the Effectiveness of Detection of M. tuberculosis and Rifampin Resistance Using Xpert MTB/RIF

Ji-Young Jeong¹, Seon-Heui Lee¹, Sunyoung Jang²

¹Health Technology Assessment Department, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

²Department of Nursing, Hanseo University, Seosan, Korea

Correspondence: Sunyoung Jang, Department of Nursing, Hanseo University, 46 Hanseo 1-ro, Haemi-myeon, Seosan 356-706, Korea. (Tel) 82-41-660-1578, (Fax) 82-41-660-1087, (E-mail) sjang@hanseo.ac.kr

Received 19 February 201426 May 2014 Accepted 27 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

The purpose of this study was to evaluate the effectiveness of Xpert MTB/RIF (Cepheid, USA) in the detection of Mycobacterium tuberculosis and to determine rifampin resistance.

Methods

The literature review covered the period from 16 August 2011 to 1 October 2011, and eight domestic databases and foreign databases including Ovid-Medline, Embase, and Cochrane Library were used. Key words, such as ‘Rifampin, Polymerase Chain Reaction,’ ‘GeneXpert’ and ‘Xpert MTB-RIF’ were used to search a total of 1,385 documents. The SIGN (Scottish Intercollegiate Guidelines Network) tool was used to evaluate the quality of the 20 selected studies.

Results

Test accuracy for the detection of M. tuberculosis was assessed on the basis of 20 studies using the M. tuberculosis culture test as the reference standard. The acid-fast bacteria smearing test had a sensitivity in the range of 0.69-1.00, specificity in the range of 0.72-1.00 and test accuracy in the range of 0.75-1.00. Test accuracy regarding rifampin resistance was assessed on the basis of 17 studies. Using an antituberculosis agent sensitivity test as the reference standard, the sensitivity, specificity and test accuracy of real-time, nested PCR were in the ranges of 0.75-1.00, 0.96-1.00 and 0.95-1.00, respe-ctively.

Conclusion

Xpert MTB/RIF is a useful test for patients suspected of having rifampin-resistant tuberculosis.

Keywords: Meta-analysis, Multidrug-resistant, Polymerase chain reaction, Rifampin, Tuberculosis

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Fig. 1.

Documents selected for evaluation of Xpert MTB/RIF according to the literature search strategy.

Fig. 2.

Forest plot of sensitivities of Xpert MTB/RIF (Detection of M. tuberculosis).

Fig. 3.

ROC curve of Xpert MTB/RIF (Detection of M. tuberculosis)(AUC=0.9754).

Fig. 4.

Forest plot of sensitivities of Xpert MTB/RIF (Rifampin Resistance).

Fig. 5.

ROC curve of Xpert MTB/RIF (Rifampin Resistance) (AUC=0.9754).

Table 1.

Levels of evidence [9]

1++	High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+	Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1-	Meta-analyses, systematic reviews, or RCTs with a high risk of bias
2++	High quality systematic reviews of case control or cohort or studiesHigh quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal
2+	Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
2-	Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3	Non-analytic studies, e.g. case reports, case series
4	Expert opinion

Table 2.

Grades of recommendations [9]

A	At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating overall consistency of results
B	Abody of evidence including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+
C	A body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++
D	Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+

Table 3.

Documents selected for evaluation of Xpert MTB/RIF

No	Author (Publication year)	Research location Insi	No. of cases
No	Author (Publication year)	Research location Insi	inside lung sample	Outside lung sample
1	Armand (2011) [19]∗	France	60	37
2	Boehme (2011) [10]	South Africa, Peru, India, Azerbaijan, Philippines, Uganda	3,909	-
3	Bowles (2011) [4]∗	Netherlands	87	2
4†	Causse (2011) [5]∗	Spain	-	340
5	Friedrich (2011) [11]	South Africa	140	-
6	Hillemann (2011) [20]∗	Germany	-	521
7	Ioannis (2011) [12]	Greece	80	41
8	Lawn (2011) [13]	South Africa	839	-
9	Malbruny (2011) [14]	France	91	89
10	Marlowe (2011) [21]∗	USA	217	-
11†	Miller (2011) [22]∗	USA	89	23
12	Moure (2011) [23]∗	Spain	105	20
13	Rachow (2011) [15]	Tanzania	172	-
14	Scott (2011) [7]∗	South Africa	177	-
15†	Teo (2011) [24]∗	Singapore	131	31
16	Theron (2011) [16]	South Africa	480	-
17	Vadwai (2011) [17]	India	-	547
18	Blakemore (2010) [6]∗	USA	168	-
19	Boehme (2010) [8]	Peru, Azerbaijan, South Africa, India	1,462	-
20	Helb (2010) [18]	Vietnam, Uganda	107	64

^∗ Level of evidence = ‘-’;

^† Only included in evaluation of Detection of M. tuberculosis.

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