Defining drug resistance beyond rifampicin: use of Xpert® MTB/XDR assay in tuberculous meningitis

IF 1.4 4区医学 Q4 IMMUNOLOGY

Indian Journal of Medical Microbiology Pub Date : 2025-07-01 DOI:10.1016/j.ijmmb.2025.100912

Kusum Sharma , Megha Sharma , Ritu Shree , Himanshu Joshi , Neeraj Singla , Ashish Kumar Kakkar , Vijeta Patial , Chamanjot Kaur , Supriya Sharma , Manoj Goyal , Aman Sharma , Navneet Sharma , Manish Modi

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引用次数: 0

Abstract

Purpose

– The emerging drug resistance in Tuberculous meningitis (TBM) worsens the prognosis and hamper elimination efforts. The need of the hour is a relatively simple, rapid, near point-of-care test that could allow universal drug susceptibility testing, beyond rifampicin (RIF). The current study evaluated performance of Xpert MTB/XDR in defining drug resistant TBM.

Methods

– A total of 45 cerebrospinal fluid samples (29 culture-positive, 16 culture-negative) reported TBM by Xpert MTB/Ultra were subjected to Xpert MTB/XDR to determine susceptibility towards isoniazid (INH), fluoroquinolones (FLQ), second-line injectables (SLID) and ethambutol (ETM). The performance of Xpert MTB/XDR was evaluated against genotypic drug susceptibility testing (line probe assay (LPA) and phenotypic drug susceptibility testing (culture)).

Results

– There was 100 % concordance between Xpert MTB/XDR and drug susceptibility using both culture and LPA for INH and SLIDs. For FLQ, the sensitivity and specificity of Xpert MTB/XDR was 93 % and 100 %, respectively against both culture and LPA, as there was one case each reported false-susceptible by Xpert MTB/XDR. The sensitivity and specificity of Xpert MTB/XDR for ETM was 93 % and 100 %, respectively against culture and one case of false-resistance was reported.

Conclusion

– Xpert MTB/XDR can serve as a useful tool to rapidly identify resistance to INH, FLQ, SLID and ETM, thus offering targeted therapy to the patients of TBM.

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定义利福平以外的耐药：结核性脑膜炎中使用Xpert®MTB/XDR试验

目的：结核性脑膜炎（TBM）中出现的耐药性恶化了预后并阻碍了消除工作。一小时的需求是一种相对简单、快速、近护理点的测试，可以进行除利福平（RIF）之外的普遍药物敏感性测试。目前的研究评估了Xpert MTB/XDR在定义耐药TBM方面的表现。方法：对经Xpert MTB/Ultra检测报告的45份脑脊液标本（培养阳性29份，培养阴性16份）进行Xpert MTB/XDR检测，测定异烟肼（INH）、氟喹诺酮类药物（FLQ）、二线注射剂（SLID）和乙胺丁醇（ETM）的敏感性。通过基因型药敏试验（线探针法（LPA））和表型药敏试验（培养）对Xpert MTB/XDR进行性能评价。结果：Xpert MTB/XDR与INH和slds的培养和LPA药物敏感性之间的一致性为100%。对于FLQ， Xpert MTB/XDR对培养和LPA的敏感性和特异性分别为93%和100%，因为Xpert MTB/XDR各报告1例假敏感。Xpert MTB/XDR检测ETM的培养敏感性为93%，特异性为100%，报告1例假耐药。结论：Xpert MTB/XDR可作为快速鉴定INH、FLQ、SLID和ETM耐药的有效工具，从而为TBM患者提供靶向治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Medical Microbiology IMMUNOLOGY-

CiteScore

2.20

自引率

0.00%

发文量

154

审稿时长

73 days

期刊介绍： Manuscripts of high standard in the form of original research, multicentric studies, meta analysis, are accepted. Current reports can be submitted as brief communications. Case reports must include review of current literature, clinical details, outcome and follow up. Letters to the editor must be a comment on or pertain to a manuscript already published in the IJMM or in relation to preliminary communication of a larger study. Review articles, Special Articles or Guest Editorials are accepted on invitation.