Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults

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Xpert® MTB/RIF used as initial diagnostic test for TB detection in patients suspected of having TB, MDR-TR or HIV-associated TB is sensitive and specific. Compared with smear microscopy, Xpert® MTB/RIF substantially increases TB detection among culture-confirmed cases. Xpert® MTB/RIF may also be valuable as an add-on test following microscopy for patients who have previously been found to be smear-negative. For rifampicin resistance detection, Xpert® MTB/RIF provides accurate results and can allow rapid initiation of MDR-TB treatment.

Accurate and rapid detection of tuberculosis (TB) and drug resistance are critical for improving patient care and decreasing the spread of TB. Xpert® MTB/RIF assay (Xpert) is a rapid, automated test that can detect both TB and rifampicin resistance, within two hours after starting the test, with minimal hands-on technical time, but is more expensive than conventional sputum microscopy. This review assessed the diagnostic accuracy of Xpert for pulmonary TB (TB detection), both where Xpert was used as an initial test replacing microscopy, and where Xpert was used as an add-on test following a negative smear microscopy result. It also assessed the diagnostic accuracy of Xpert for rifampicin resistance detection where Xpert was used as the initial test, replacing conventional culture-based drug susceptibility testing. The assessment was made in the adult population suspected of having pulmonary TB or multidrug-resistant TB (MDR-TB), with or without HIV infection. Most studies were performed in high TB burden countries.

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