Arentz M., Sorensen B., Horne D.J., Walson J.L.
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, United States; Center for AIDS Research, University of Washington, Seattle, WA, United States; Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, United States; Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Arentz, M., Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, United States; Sorensen, B., Center for AIDS Research, University of Washington, Seattle, WA, United States; Horne, D.J., Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, United States; Walson, J.L., Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, United States, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Introduction:Rapid tests for rifampicin resistance may be useful for identifying isolates at high risk of drug resistance, including multidrug-resistant TB (MDR-TB). However, choice of diagnostic test and prevalence of rifampicin resistance may both impact a diagnostic strategy for identifying drug resistant-TB. We performed a systematic review to evaluate the performance of WHO-endorsed rapid tests for rifampicin resistance detection.Methods:We searched MEDLINE, Embase and the Cochrane Library through January 1, 2012. For each rapid test, we determined pooled sensitivity and specificity estimates using a hierarchical random effects model. Predictive values of the tests were determined at different prevalence rates of rifampicin resistance and MDR-TB.Results:We identified 60 publications involving six different tests (INNO-LiPA Rif. TB assay, Genotype MTBDR assay, Genotype MTBDRplus assay, Colorimetric Redox Indicator (CRI) assay, Nitrate Reductase Assay (NRA) and MODS tests): for all tests, negative predictive values were high when rifampicin resistance prevalence was ≤ 30%. However, positive predictive values were considerably reduced for the INNO-LiPA Rif. TB assay, the MTBDRplus assay and MODS when rifampicin resistance prevalence was < 5%.Limitations:In many studies, it was unclear whether patient selection or index test performance could have introduced bias. In addition, we were unable to evaluate critical concentration thresholds for the colorimetric tests.Discussion:Rapid tests for rifampicin resistance alone cannot accurately predict rifampicin resistance or MDR-TB in areas with a low prevalence of rifampicin resistance. However, in areas with a high prevalence of rifampicin resistance and MDR-TB, these tests may be a valuable component of an MDR-TB management strategy. © 2013 Arentz et al.
rifampicin; antibiotic resistance; article; diagnostic accuracy; diagnostic test accuracy study; drug resistant tuberculosis; human; intermethod comparison; meta analysis; predictive value; prevalence; sensitivity and specificity; systematic review; tuberculosis rapid test; Antitubercular Agents; Bias (Epidemiology); Drug Resistance, Multiple, Bacterial; Humans; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Predictive Value of Tests; Reagent Kits, Diagnostic; Rifampin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary