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Tuberculosis (TB) is the cause of more deaths worldwide than any other infectious disease and is one of the top 10 leading causes of death in the world. Globally, in 2017, out of the 10 million people with TB, 3.6 million have not been reported to national TB programs, and many of them have not been reported to national TB programs. did not receive a diagnosis of their disease. If it is detected early and treated effectively, TB is largely curable, but in 2017, about 1.6 million people died of TB, including 300,000 people living with HIV.
Xpert MTB / RIF and Xpert Ultra, the most recent version, are the only diagnostic tests recommended by the World Health Organization (WHO) to quickly and simultaneously detect tuberculosis and rifampicin resistance in people with signs and symptoms of tuberculosis. lower levels of the health system.
This update of the Cochrane Review is part of a series of Cochrane Reviews that will guide a forthcoming meeting of the WHO to update the guidelines for these tests.
Main results of this update of the Cochrane review:
• The review identified 95 studies, incorporating 77 new studies since the previous Cochrane review.
• For the detection of pulmonary TB, the sensitivity and specificity of Xpert MTB / RIF were 85% and 98%.
• For the detection of rifampicin resistance, the sensitivity and specificity of Xpert MTB / RIF were 96% and 98%.
• In a study that directly compared Xpert Ultra and Xpert MTB / RIF, Xpert Ultra revealed a higher sensitivity (88%) than Xpert MTB / RIF (83%) and a lower specificity (96%) than Xpert MTB / RIF (98%).
The author's team found that Xpert MTB / RIF was sensitive and specific to the diagnosis of resistance to pulmonary TB and rifampicin, consistent with previously reported findings. Compared to Xpert MTB / RIF, Xpert Ultra had higher sensitivity and lower specificity for TB detection and similar sensitivity and specificity for the detection of rifampicin resistance (one study). Xpert MTB / RIF and Xpert Ultra provide accurate results and can quickly initiate treatment for multidrug-resistant TB. The continued use of Xpert MTB / RIF or Xpert Ultra in TB control programs in high TB burden settings, as well as in primary care clinics where the test offers the opportunity to start treatment early, will prove that their use leads to an improvement in the health of the patient.
We hope that this update of the Cochrane Review will allow anyone interested to find high quality information about Xpert MTB / RIF and Xpert Ultra. "
Karen Steingart, Editor and Reviewer, Cochrane Infectious Diseases Group (CIDG)
Lead author, Associate Professor David Horne (University of Washington, Seattle), added: "Future studies should evaluate the diagnostic accuracy of Xpert Ultra over other rapid tests for tuberculosis detection." and drug resistance, especially in hard-to-diagnose groups, such as children, people living with HIV, and people with extrapulmonary TB Understanding the impact of Xpert Ultra on patient health outcomes will be important. "
This Cochrane Literature Review was coordinated by the CIDG, whose editorial base is at LSTM. The CIDG has been operational since 1994 and brings together more than 600 authors from 52 countries. It is supported by the United Kingdom for badistance to low- and middle-income countries (Project No. 300342-104).
Source:
Liverpool School of Tropical Medicine
Journal reference:
Horne, DJ. et al. (2019) Xpert MTB / RIF and Xpert MTB / RIF Ultra for pulmonary tuberculosis and resistance to rifampicin in adults. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD009593.pub4.
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