Performance of Diagnostic Methods for Detection of Drug Resistance Among New Cases of Mycobacterium tuberculosis

Paul A. Akinduti; Oluwaseun  Ejilude; Oluwatoyin C.  Ajanaku; Akinwande  Kazeem; John O  Akinbo; Olumuyiwa Emmanuel  Olukayode; Chineye P.  Nwaejigh; Zainab Ifeoluwani  Adenekan; Akintunde A.  Akinjinmi; Temitope T.  Banjo

Authors

Paul A. Akinduti Department of Medical Laboratory Science, Babcock University, Illishan, Nigeria https://orcid.org/0000-0003-0697-8176
Oluwaseun Ejilude Institute of Human Virology, Abuja, Nigeria
Oluwatoyin C. Ajanaku Department of Chemistry, Covenant University, Ota, Nigeria https://orcid.org/0000-0001-6408-2779
Akinwande Kazeem Department of Chemical Pathology and Immunology, Federal Medical Center Abeokuta, Ogun State, Nigeria; Department of Biochemistry, Federal University of Medicine and Medical Sciences Abeokuta, Ogun State, Nigeria
John O Akinbo Department of Medical Microbiology, Federal Medical Center Abeokuta, Ogun State, Nigeria
Olumuyiwa Emmanuel Olukayode Department of Biological Sciences, Bells University of Technology, Ota, Ogun State, Nigeria
Chineye P. Nwaejigh Department of Medical Laboratory Science, Babcock University, Illishan, Nigeria
Zainab Ifeoluwani Adenekan Department of Biology, Georgia State University, USA
Akintunde A. Akinjinmi Department of Medical Laboratory Science, Babcock University, Illishan, Nigeria
Temitope T. Banjo Department of Microbiology, Crawford University, Igbesa, Ogun State, Nigeria

Keywords:

acid-fast bacilli, tuberculosis, MDR-Mycobacterium tuberculosis, rifampicin, resistance predictor

Abstract

Objective The increasing incidence of new cases of drug resistant-TB (DR-TB) infection is worrisome, with high rates of new pulmonary morbidities occurring mostly among the vulnerable populations. The performance of diagnostic methods of GeneXpert MTB/RIF assay and phenotypic Drug Susceptibility Test (pDST) for detection of drug resistance among new cases of Mycobacterium tuberculosis (MTB) infections was evaluated.

Methods Sputum samples (n = 546) from newly suspected MTB cases were analysed for phenotypic drug resistance using BACTEC MGIT (B-MGIT) and genotyped with xpert MTB/RIF assay. The predictive performance of B-MGIT culture-based methods and xpert MTB/RIF assay for MTB detection were determined.

Results Of the collected sputum samples (n = 546), the highest rates of phenotypic drug resistance (66.7%) were AFB3+ smear positive and MTB with detection rates of 98.2% and 92.7%, respectively, with B-GMIT and Xpert MTB/RIF (p = 0.63). B-MGIT detected higher resistance rates to isoniazide (inh) and rifampicin (rif) of more than 60.0%, and less than 20% resistance to ofloxacin (ofx) and protionamide (proth) compared to Xpert (p < 0.05). B-MGIT had a higher detection rate (98.2%), sensitivity (87.8%), specificity (91.4%), positive predictive value (PPV) (95.8%) (95%CI: 0.778-1.04; p = 0.001) and likelihood of detection of rifampicin resistance (OR:5.76;95%CI:1.01-7.56) compared to Xpert MTB/RIF methods. B-MGIT provided higher AUC-rifampicin of 0.9339 (95%CI: 0.8398 to 1.000) than gene xpert (AUC-rifampicin = 0.9019 [95%CI: 0.7899 to 1.000]). B-MGIT is needed for further confirmation of new cases of MTB identified from acid-fast bacilli (AFB) smear positive sputum.

Conclusions The inclusion of B-MGIT examination of sputum in new TB cases would enhance early detection of drug resistant MTB, mostly from rifampicin negative sputum investigated with GeneXpert and mostly in low resource settings.

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