One- versus two-specimen Xpert strategy to discontinue airborne isolation in suspected pulmonary tuberculosis : systematic review and meta-analysis
Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved..
BACKGROUND: Evaluation of a patient with suspected pulmonary tuberculosis (TB) involves initiation of airborne infection isolation (AII). However, guidelines detailing discontinuation of AII utilizing the Xpert MTB/RIF provide little clarity between use of one-specimen (1-Xpert') versus two-specimens (2-Xpert').
OBJECTIVES: To evaluate the diagnostic accuracy of one-Xpert versus two-Xpert strategy in guiding discontinuation of AII.
METHODS: Data sources: PubMed, Embase, and EBSCO databases.
STUDY ELIGIBILITY CRITERIA: Studies providing diagnostic accuracy data for one- versus two-Xperts in discontinuation of AII.
PARTICIPANTS: Adult patients with suspected TB.
TESTS: Xpert MTB/RIF on one- versus two-sputum specimens. Reference standard: Solid and liquid culture media. Assessment of risk of bias: Quality Assessment of Diagnostic Accuracy Studies tool was used. Methods of data synthesis: Meta-analysis was performed to calculate the pooled sensitivities and specificities using Stata 17.2.
RESULTS: Four studies were included involving 1776 patients. A total of 68% were males, 36% were HIV positive, and 80% participants belonged to the United States. In patients with suspected pulmonary TB, 7% (95% CI, 6-9%) participants were found to have culture-positive MTB. For one-Xpert strategy, the pooled sensitivity was 86% (95% CI, 75-92%; I2, 1.05%) and specificity was 100% (95% CI, 99-100%; I2, 36%). Two-Xpert strategy had a pooled sensitivity of 92% (95% CI, 84-96%; I2, 16%) and a specificity of 100% (95% CI, 98-100%; I2, 27%). There was statistically significant difference between sensitivities of one-Xpert and two-Xpert strategies (p 0.05) with no statistically significant difference in their specificities.
DISCUSSION: The results of this review must be interpreted in the context of a predominantly low-TB prevalence setting. Two-Xpert strategy has an incrementally higher sensitivity when compared with one-Xpert strategy with similar specificities between the two. Obtaining a second Xpert is crucial for individuals with a continued high suspicion for TB or those at a high risk of morbidity/mortality from TB.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - (2023) vom: 20. Juli |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gandhi, Tanmay [VerfasserIn] |
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| Links: |
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| Themen: |
Airborne infection isolation |
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| Anmerkungen: |
Date Revised 11.08.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.cmi.2023.07.010 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359795153 |
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| 100 | 1 | |a Gandhi, Tanmay |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a One- versus two-specimen Xpert strategy to discontinue airborne isolation in suspected pulmonary tuberculosis |b systematic review and meta-analysis |
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| 500 | |a Date Revised 11.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Evaluation of a patient with suspected pulmonary tuberculosis (TB) involves initiation of airborne infection isolation (AII). However, guidelines detailing discontinuation of AII utilizing the Xpert MTB/RIF provide little clarity between use of one-specimen (1-Xpert') versus two-specimens (2-Xpert') | ||
| 520 | |a OBJECTIVES: To evaluate the diagnostic accuracy of one-Xpert versus two-Xpert strategy in guiding discontinuation of AII | ||
| 520 | |a METHODS: Data sources: PubMed, Embase, and EBSCO databases | ||
| 520 | |a STUDY ELIGIBILITY CRITERIA: Studies providing diagnostic accuracy data for one- versus two-Xperts in discontinuation of AII | ||
| 520 | |a PARTICIPANTS: Adult patients with suspected TB | ||
| 520 | |a TESTS: Xpert MTB/RIF on one- versus two-sputum specimens. Reference standard: Solid and liquid culture media. Assessment of risk of bias: Quality Assessment of Diagnostic Accuracy Studies tool was used. Methods of data synthesis: Meta-analysis was performed to calculate the pooled sensitivities and specificities using Stata 17.2 | ||
| 520 | |a RESULTS: Four studies were included involving 1776 patients. A total of 68% were males, 36% were HIV positive, and 80% participants belonged to the United States. In patients with suspected pulmonary TB, 7% (95% CI, 6-9%) participants were found to have culture-positive MTB. For one-Xpert strategy, the pooled sensitivity was 86% (95% CI, 75-92%; I2, 1.05%) and specificity was 100% (95% CI, 99-100%; I2, 36%). Two-Xpert strategy had a pooled sensitivity of 92% (95% CI, 84-96%; I2, 16%) and a specificity of 100% (95% CI, 98-100%; I2, 27%). There was statistically significant difference between sensitivities of one-Xpert and two-Xpert strategies (p 0.05) with no statistically significant difference in their specificities | ||
| 520 | |a DISCUSSION: The results of this review must be interpreted in the context of a predominantly low-TB prevalence setting. Two-Xpert strategy has an incrementally higher sensitivity when compared with one-Xpert strategy with similar specificities between the two. Obtaining a second Xpert is crucial for individuals with a continued high suspicion for TB or those at a high risk of morbidity/mortality from TB | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Airborne infection isolation | |
| 650 | 4 | |a Diagnostic accuracy | |
| 650 | 4 | |a Isolation precautions | |
| 650 | 4 | |a Mycobacterium tuberculosis | |
| 650 | 4 | |a Nucleic acid amplification test | |
| 650 | 4 | |a Sputum | |
| 700 | 1 | |a Shah, Aniruddh |e verfasserin |4 aut | |
| 700 | 1 | |a Gautam, Nitesh |e verfasserin |4 aut | |
| 700 | 1 | |a Meena, Nikhil |e verfasserin |4 aut | |
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| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.cmi.2023.07.010 |3 Volltext |
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