The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis

Beatrice Achan; Benon B. Asiimwe; Moses L. Joloba; Mourad Gumusboga; Willy Ssengooba; Freddie Bwanga

doi:10.1099/jmm.0.001331

The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis

Beatrice Achan, Benon B. Asiimwe, Moses L. Joloba, Mourad Gumusboga, Willy Ssengooba, Freddie Bwanga

Mycobacteriology

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.

Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low-and middle-income settings.

Aim. The technical performance and time to results of a simple, direct microscopy -based slide DST (SDST) assay for diagnosis of rifampicinresistant TB was evaluated in Uganda.

Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda & rsquo;s National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.

Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10 & ndash;14 days compared to 60 days with IQR of 60 & ndash;75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81 & ndash;99 %) and a specificity of 97.8 % (95 %; CI 93 & ndash;100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8 & ndash;99 %) and 98.9 % (95 %; CI 94 & ndash;100 %), respectively. The kappa agreement between SDST and LJDST was 92.3%.

Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.

Original language	English
Article number	001331
Journal	Journal of Medical Microbiology
Volume	70
Issue number	3
Number of pages	5
ISSN	0022-2615
DOIs	https://doi.org/10.1099/jmm.0.001331
Publication status	Published - 2021

Keywords

Slide DST
Rifampicin resistant tuberculosis

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10.1099/jmm.0.001331

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@article{58d5dc5133a64bcb9ae1a26bda1aacfa,

title = "The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis",

abstract = "Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low-and middle-income settings.Aim. The technical performance and time to results of a simple, direct microscopy -based slide DST (SDST) assay for diagnosis of rifampicinresistant TB was evaluated in Uganda.Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda & rsquo;s National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10 & ndash;14 days compared to 60 days with IQR of 60 & ndash;75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81 & ndash;99 %) and a specificity of 97.8 % (95 %; CI 93 & ndash;100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8 & ndash;99 %) and 98.9 % (95 %; CI 94 & ndash;100 %), respectively. The kappa agreement between SDST and LJDST was 92.3%.Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.",

keywords = "Slide DST, Rifampicin resistant tuberculosis",

author = "Beatrice Achan and Asiimwe, {Benon B.} and Joloba, {Moses L.} and Mourad Gumusboga and Willy Ssengooba and Freddie Bwanga",

note = "NPP; OGOA",

year = "2021",

doi = "10.1099/jmm.0.001331",

language = "English",

volume = "70",

journal = "Journal of Medical Microbiology",

issn = "0022-2615",

publisher = "American Society for Microbiology",

number = "3",

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TY - JOUR

T1 - The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis

AU - Achan, Beatrice

AU - Asiimwe, Benon B.

AU - Joloba, Moses L.

AU - Gumusboga, Mourad

AU - Ssengooba, Willy

AU - Bwanga, Freddie

N1 - NPP; OGOA

PY - 2021

Y1 - 2021

N2 - Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low-and middle-income settings.Aim. The technical performance and time to results of a simple, direct microscopy -based slide DST (SDST) assay for diagnosis of rifampicinresistant TB was evaluated in Uganda.Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda & rsquo;s National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10 & ndash;14 days compared to 60 days with IQR of 60 & ndash;75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81 & ndash;99 %) and a specificity of 97.8 % (95 %; CI 93 & ndash;100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8 & ndash;99 %) and 98.9 % (95 %; CI 94 & ndash;100 %), respectively. The kappa agreement between SDST and LJDST was 92.3%.Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.

AB - Introduction. Drug resistant tuberculosis remains a worldwide problem that requires prompt diagnosis.Hypothesis/Gap statement. The WHO recommended direct, rapid Xpert MTB/RIF is prohibitively costly, therefore, there is a need to validate a rapid, affordable DST for use in low-and middle-income settings.Aim. The technical performance and time to results of a simple, direct microscopy -based slide DST (SDST) assay for diagnosis of rifampicinresistant TB was evaluated in Uganda.Methodology. Sputum samples from 122 smear-positive re-treatment TB patients presenting to the TB treatment centre at Uganda & rsquo;s National Referral Hospital, Mulago, Kampala, Uganda were examined. The sputum samples were tested by the direct SDST which was compared to the indirect Lowenstein Jensen Proportion Method (LJDST) method as the gold standard. The time to results was defined as the time from DST setting to results interpretation. The results were further analysed for sensitivity and specificity as well as agreement between LJDST and SDST for rifampicin resistance determination.Results. A total of 117 smear positive sputum samples with valid results for both tests were compared. The median time to results for SDST was 14 days with an interquartile range (IQR) of 10 & ndash;14 days compared to 60 days with IQR of 60 & ndash;75 days for LJDST. The number for rifampicin resistance by the gold standard LJDST was 26. The SDST had a sensitivity of 96 % (95 %; CI 81 & ndash;99 %) and a specificity of 97.8 % (95 %; CI 93 & ndash;100 %). The Positive Predictive and Negative Predictive values for SDST were 92.3 % (95 %; CI 76.8 & ndash;99 %) and 98.9 % (95 %; CI 94 & ndash;100 %), respectively. The kappa agreement between SDST and LJDST was 92.3%.Conclusion. The SDST was found to be a rapid and accurate direct test for the detection of rifampicin resistance among retreatment TB cases in low-income settings.

KW - Slide DST

KW - Rifampicin resistant tuberculosis

U2 - 10.1099/jmm.0.001331

DO - 10.1099/jmm.0.001331

M3 - A1: Web of Science-article

SN - 0022-2615

VL - 70

JO - Journal of Medical Microbiology

JF - Journal of Medical Microbiology

IS - 3

M1 - 001331

ER -

The simple direct slide method is comparable to indirect Lowenstein Jensen proportion culture for detecting rifampicin resistant tuberculosis

Abstract

Keywords

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