Moore, David AJ; Evans, Carlton AW; Gilman, Robert H; Caviedes, Luz; Coronel, Jorge; Vivar, Aldo; Sanchez, Eduardo; Piñedo, Yvette; Saravia, Juan Carlos; Salazar, Cayo; +5 more... Oberhelman, Richard; Hollm-Delgado, Maria-Graciela; LaChira, Doris; Escombe, A Roderick; Friedland, Jon S; (2006) Microscopic-observation drug-susceptibility assay for the diagnosis of TB. The New England journal of medicine, 355 (15). pp. 1539-1550. ISSN 0028-4793 DOI: https://doi.org/10.1056/NEJMoa055524
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Abstract
BACKGROUND: New diagnostic tools are urgently needed to interrupt the transmission of tuberculosis and multidrug-resistant tuberculosis. Rapid, sensitive detection of tuberculosis and multidrug-resistant tuberculosis in sputum has been demonstrated in proof-of-principle studies of the microscopic-observation drug-susceptibility (MODS) assay, in which broth cultures are examined microscopically to detect characteristic growth. METHODS: In an operational setting in Peru, we investigated the performance of the MODS assay for culture and drug-susceptibility testing in three target groups: unselected patients with suspected tuberculosis, prescreened patients at high risk for tuberculosis or multidrug-resistant tuberculosis, and unselected hospitalized patients infected with the human immunodeficiency virus. We compared the MODS assay head-to-head with two reference methods: automated mycobacterial culture and culture on Löwenstein-Jensen medium with the proportion method. RESULTS: Of 3760 sputum samples, 401 (10.7%) yielded cultures positive for Mycobacterium tuberculosis. Sensitivity of detection was 97.8% for MODS culture, 89.0% for automated mycobacterial culture, and 84.0% for Löwenstein-Jensen culture (P<0.001); the median time to culture positivity was 7 days, 13 days, and 26 days, respectively (P<0.001), and the median time to the results of susceptibility tests was 7 days, 22 days, and 68 days, respectively. The incremental benefit of a second MODS culture was minimal, particularly in patients at high risk for tuberculosis or multidrug-resistant tuberculosis. Agreement between MODS and the reference standard for susceptibility was 100% for rifampin, 97% for isoniazid, 99% for rifampin and isoniazid (combined results for multidrug resistance), 95% for ethambutol, and 92% for streptomycin (kappa values, 1.0, 0.89, 0.93, 0.71, and 0.72, respectively). CONCLUSIONS: A single MODS culture of a sputum sample offers more rapid and sensitive detection of tuberculosis and multidrug-resistant tuberculosis than the existing gold-standard methods used.
Item Type | Article |
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Keywords | Adult, Bacteriological Techniques, Female, HIV Infections, Humans, Male, Microbial Sensitivity Tests/*methods, Microscopy, Mycobacterium tuberculosis/*isolation & purification, Predictive Value of Tests, Sensitivity and Specificity, Sputum/*microbiology, Tuberculosis/*diagnosis/microbiology, Tuberculosis, Multidrug-Resistant/diagnosis/microbiology |
Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
Research Centre | TB Centre |
PubMed ID | 17035648 |
ISI | 241160400005 |
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