检测利福平和异烟肼耐药结核分枝杆菌的基因型和表型方法之间的不一致以及与患者治疗结果的相关性

IF 1.9 Q3 INFECTIOUS DISEASES
Zegeye Bonsa , Mulualem Tadesse , Getu Balay , Wakjira Kebede , Gemeda Abebe
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引用次数: 0

摘要

背景准确的结核分枝杆菌(MTB)药敏试验(DST)对于正确管理患者至关重要。我们调查了埃塞俄比亚西南奥罗米亚州吉马市基因型(Xpert MTB/RIF 和 MTBDRplus)和表型(MGIT 960)方法检测利福平(RIF)和异烟肼(INH)耐药 MTB 的不一致性及其与患者治疗结果的相关性。方法 从 2021 年 11 月 2 日至 2022 年 12 月 28 日,我们在吉马大学分枝杆菌学研究中心对 57 例已知 Xpert RIF 耐药状态的 MTB 分离物(45 例 RIF 耐药,12 例 RIF 易感)进行了回顾性研究。我们进行了 MTBDRplus 和表型 DST 检测(使用分枝杆菌生长指示管 (MGIT) 系统)。将表型 DST 作为参考标准方法,比较了 Xpert 和 MTBDRplus 的结果。治疗结果根据国家指南确定。结果在 57 个 MTB 分离物中,有 6 个(10.5%)在两种 DST 方法中结果不一致。与表型 DST 相比,Xpert 得到了 5 个不一致的 RIF 结果(卡帕系数 (κ) = 0.76,95% 置信区间为 0.56-0.96)。与表型 DST 相比,MTBDRplus 对 RIF(κ = 0.86,95% 置信区间为 0.71-1.00)和 INH(κ = 0.86,95% 置信区间为 0.70-1.00)的检测结果有三次不一致。与 Xpert 相比,MTBDRplus 与 RIF 表型 DST 的不一致性较低。在结果不一致的六名患者中,三名患者的治疗效果不佳,而另外三名患者则痊愈了。在结果不一致的三名患者中,只有一名患者接受了不恰当的治疗方案。结论 10.5%的分离菌株的 RIF 或 INH 基因型和表型 DST 不一致。只有一名结果不一致的患者接受了不恰当的治疗方案,导致了不利的结果。同时使用快速分子检测和表型 DST 对患者治疗结果的影响需要进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Discordance between genotypic and phenotypic methods for the detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis and the correlation with patient treatment outcomes

Background

Accurate drug susceptibility testing (DST) of Mycobacterium tuberculosis (MTB) is essential for proper patient management. We investigated discordance between genotypic (Xpert MTB/RIF and MTBDRplus) and phenotypic (MGIT 960) methods for the detection of rifampicin (RIF) and isoniazid (INH) resistant MTB and its correlation with patient treatment outcomes in Jimma, Southwest Oromia, Ethiopia.

Methods

A retrospective study was conducted on 57 stored MTB isolates with known Xpert RIF resistance status (45 RIF resistant and 12 RIF susceptible) at Jimma University Mycobacteriology Research Center from November 2, 2021, to December 28, 2022. We did MTBDRplus and phenotypic DST (using the Mycobacterial Growth Indicator Tube (MGIT) system). The Xpert and MTBDRplus results were compared using phenotypic DST as a reference standard method. The treatment outcome was determined as per national guideline. The discordance between the genotypic and phenotypic DST was calculated using GraphPad software.

Results

Among the 57 MTB isolates, six (10.5 %) had discordant results between the two DST methods. Xpert yielded five discordant results for RIF when compared with phenotypic DST (kappa coefficient (κ) = 0.76, 95 % confidence interval 0.56–0.96). The MTBDRplus compared with phenotypic DST gave three discordant results for RIF (κ = 0.86, 95 % confidence interval 0.71–1.00) and three for INH (κ = 0.86, 95 % confidence interval 0.70–1.00). Compared with Xpert, MTBDRplus yielded lower discordance with phenotypic DST for RIF. Out of six patients with discordant results, three had unfavorable outcomes while the other three were cured. Of the three patients with unfavorable outcomes, only one patient has received an inappropriate treatment regimen. There was no correlation between unfavorable outcomes and incorrect treatment regimens due to discordant results (Χ2 = 0.404; P = 0.525).

Conclusions

Discordance between genotypic and phenotypic DST for RIF or INH occurred in 10.5 % of isolates. Only one patient with discordant results has received an inappropriate treatment regimen, resulting in an unfavorable outcome. The impact of parallel use of rapid molecular assay with phenotypic DST on patient treatment outcomes requires further study.

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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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