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Xpert MTB/XDR assay: rapid TB drug resistance detection

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Abstract

Purpose

To assess the Xpert MTB/XDR assay’s efficiency in promptly detecting resistance to isoniazid, fluoroquinolones, ethionamide, and second-line injectable drugs among tuberculosis (TB) patients.

Methods

From August 2020 to July 2021, TB suspected patient samples were enrolled at a tertiary care center for our study. We conducted mycobacterial culture, phenotypic DST using proportion method in liquid culture at WHO-recommended concentrations, and the line probe assay (LPA). Simultaneously, the Index test, Xpert MTB/XDR, was performed following the manufacturer’s instructions.

Results

Among 360 samples, 107 were excluded due to incomplete information. Resistance to isoniazid, levofloxacin and moxifloxacin was found in 45/251, 21/251 and 20/251 samples, respectively by phenotypic DST. The diagnostic accuracy of Index test, taking phenotypic DST as a reference standard, was 95.8%, 99.04%, and 99.05% for isoniazid, levofloxacin, and moxifloxacin, respectively. The Index test assay demonstrated a specificity of 99.1% for detecting SLID resistance, yielding a diagnostic accuracy of 99.2. Comparing the Index test with LPA revealed a significant enhancement in sensitivity for detecting isoniazid resistance (86.7% vs. 82.2%).

Conclusions

The Index test exhibited promising outcomes in identifying resistance to isoniazid and fluoroquinolones, surpassing the performance of the LPA. This could be valuable for promptly initiating treatment in cases of drug-resistant tuberculosis.

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Data availability

Data will be made available upon request.

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Acknowledgements

The support from Department of Medical Microbiology, PGIMER Chandigarh and Central TB division, India is acknowledged.

Funding

No specific funding was allocated for this study.

Author information

Author notes

  1. Sunil Sethi and Shelly Sharma are combined first author.

Authors and Affiliations

  1. Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Sunil Sethi, Shelly Sharma, Sunil Kumar Dhatwalia & Rakesh Yadav

  2. Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Ashutosh N. Aggarwal

  3. State TB Cell, Chandigarh, India

    Rajesh Rana

Authors
  1. Sunil Sethi
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  2. Shelly Sharma
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  3. Ashutosh N. Aggarwal
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  4. Sunil Kumar Dhatwalia
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  5. Rajesh Rana
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  6. Rakesh Yadav
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Contributions

Dr. Sunil Sethi: experimental design, experimentation, statistical analysis, manuscript draft; Shelly Sharma: experimental work, analysis; Dr. Sunil Kumar Dhatwalia: experimental design and analysis manuscript draft; Dr. Rajesh Rana: data analysis and manuscript draft, Prof. Ashutosh N. Aggarwal: review and supervision; Dr Rakesh Yadav: experimental design, review, supervision.

Corresponding author

Correspondence to Sunil Sethi.

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The authors declare no competing interests.

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The authors have no conflicts of interest to declare.

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Sethi, S., Sharma, S., Aggarwal, A.N. et al. Xpert MTB/XDR assay: rapid TB drug resistance detection. Infection (2024). https://doi.org/10.1007/s15010-024-02260-7

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