Faculty of Epidemiology & Population Health, LSHTM, Keppel Street, London, WC1E 7HT, UK.
School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
Trans R Soc Trop Med Hyg. 2020 Sep 1;114(9):682-686. doi: 10.1093/trstmh/traa044.
The Philippines is a high TB and multidrug-resistant TB burden country. Although the scale-up of GeneXpert testing is occurring, the benefits of universal Xpert-Mycobacterium tuberculosis/ rifampicin (MTB/RIF) testing in inpatients have not been documented.
Routine GeneXpert testing irrespective of priority criteria for testing was conducted within a prospective cohort of all adults with known or presumptive TB admitted to a tertiary infectious diseases hospital in Manila. Study-specific TB diagnosis was decided upon bacteriological results, chest x-ray assessment, if already on anti-TB treatment (ATT) at admission and a cough duration of ≥2 wk.
Of submitted sputum samples, 87.1% (277/318) had valid acid-fast bacilli (AFB) microscopy and Xpert® MTB/RIF results. Xpert® MTB/RIF was positive in 97.7% (n = 87/89) of AFB-positive patients and 25.5% (n = 48/188) of AFB-negative patients. Bacteriological confirmation in smear negative cases not on ATT prior to admission was 25.2% (34/135). Rifampicin resistance was detected in 26/135 Xpert positive cases (19.3%), including nine who might not otherwise have been detected, representing a 53% increase in yield.
Universal GeneXpert testing in this setting enhanced the yield of bacterial confirmation, revealing a high incidence of rifampicin resistance and suggesting a need for further investigations in Xpert-negative/smear-positive patients who may not have mycobacterial TB.
菲律宾是一个结核病和耐多药结核病负担较高的国家。尽管 GeneXpert 检测的规模正在扩大，但尚未记录普遍进行 Xpert-结核分枝杆菌/利福平（MTB/RIF）检测对住院患者的益处。
在马尼拉一家三级传染病医院对所有已知或疑似结核病的成年住院患者进行了一项前瞻性队列研究，在该研究中，无论检测的优先标准如何，都进行常规 GeneXpert 检测。特定于研究的结核病诊断是根据细菌学结果、胸部 X 射线评估、入院时是否已经开始抗结核治疗（ATT）以及咳嗽持续时间≥2 周来确定的。
提交的痰样本中，87.1%（277/318）有有效的抗酸杆菌（AFB）显微镜和 Xpert® MTB/RIF 结果。在 AFB 阳性患者中，Xpert® MTB/RIF 阳性率为 97.7%（87/89），在 AFB 阴性患者中为 25.5%（48/188）。在入院前未接受 ATT 的 AFB 阴性患者中，细菌学确诊率为 25.2%（34/135）。在 135 例 Xpert 阳性病例中发现了利福平耐药，占 26/135（19.3%），其中包括 9 例可能无法被其他方法检测到的病例，这表明检测阴性/涂片阳性的患者中利福平耐药的发生率较高，可能需要进一步调查这些患者是否患有结核分枝杆菌。
在这种情况下，普遍进行 GeneXpert 检测提高了细菌学确诊的效果，显示出利福平耐药的高发率，并表明需要对 Xpert 阴性/涂片阳性但可能没有结核分枝杆菌的患者进行进一步调查。
