Shenyang Tenth People's Hospital and Shenyang Chest Hospital, Department of Tuberculosis, Shenyang, Liaoning Province, 110044, P.R. China.
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North), 7 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region, P.R. China.
Sci Rep. 2019 Jul 30;9(1):11053. doi: 10.1038/s41598-019-47358-3.
Genitourinary tuberculosis (GUTB) accounts for up to 40% of extrapulmonary tuberculosis cases. Rapid tests for GUTB are urgently needed because it is often associated with delayed health-care seeking, leading to serious consequences. This study evaluated the performance of the Xpert MTB/RIF assay in the rapid diagnosis of urinary tract tuberculosis (UTB) and rifampicin-resistant tuberculosis with urine specimens. In all, 302 patients were included from four hospitals in China. Suspected UTB patients were tested with Xpert, smear, and MGIT 960 culture. Drug susceptibility testing (DST) was conducted for culture-positive cases. The performance of the assays was evaluated against MGIT 960 culture and a composite reference standard (CRS). Among all participants, 150 (49.7%) had CRS-positive UTB, of whom 36 (24.0%) were culture-confirmed. Against culture, Xpert and smear achieved a sensitivity of 94.4% (95% CI: 81.3-99.3%) and 22.2% (95% CI: 10.1-39.2%), respectively. Against CRS, the sensitivity of Xpert, smear and culture was 41.3% (95% CI: 33.4-49.7%), 7.3% (95% CI: 3.7-12.7%), and 24.0% (95% CI: 17.4-31.6%). Xpert had better performance than smear and culture in detecting UTB from urine samples and could be considered for the diagnosis of UTB. Moreover, Xpert showed better performance than MGIT 960-based DST using urine culture.
泌尿生殖系统结核（GUTB）占肺外结核病例的 40%。由于 GUTB 常与延迟就医相关，导致严重后果，因此迫切需要快速检测 GUTB 的方法。本研究评估了 Xpert MTB/RIF 检测法在快速诊断尿路上皮结核（UTB）和利福平耐药结核中的尿液标本中的表现。共纳入中国 4 家医院的 302 例患者。对疑似 UTB 患者进行 Xpert、涂片和 MGIT 960 培养检测。对培养阳性的病例进行药物敏感性检测（DST）。评估这些检测方法与 MGIT 960 培养和复合参考标准（CRS）的检测性能。所有参与者中，150 例（49.7%）患有 CRS 阳性 UTB，其中 36 例（24.0%）为培养确诊。与培养相比，Xpert 和涂片的敏感性分别为 94.4%（95%CI：81.3-99.3%）和 22.2%（95%CI：10.1-39.2%）。与 CRS 相比，Xpert、涂片和培养的敏感性分别为 41.3%（95%CI：33.4-49.7%）、7.3%（95%CI：3.7-12.7%）和 24.0%（95%CI：17.4-31.6%）。Xpert 在检测尿液样本中的 UTB 方面的表现优于涂片和培养，可考虑用于 UTB 的诊断。此外，与基于 MGIT 960 的尿培养 DST 相比，Xpert 显示出更好的性能。
