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Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand

GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. This study aimed to assess physicians’ diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results a...

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Autores principales: Pongpeeradech, Nathakorn, Kasetchareo, Yuthichai, Chuchottaworn, Charoen, Lawpoolsri, Saranath, Silachamroon, Udomsak, Kaewkungwal, Jaranit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328536/
https://www.ncbi.nlm.nih.gov/pubmed/35895742
http://dx.doi.org/10.1371/journal.pone.0271130
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author Pongpeeradech, Nathakorn
Kasetchareo, Yuthichai
Chuchottaworn, Charoen
Lawpoolsri, Saranath
Silachamroon, Udomsak
Kaewkungwal, Jaranit
author_facet Pongpeeradech, Nathakorn
Kasetchareo, Yuthichai
Chuchottaworn, Charoen
Lawpoolsri, Saranath
Silachamroon, Udomsak
Kaewkungwal, Jaranit
author_sort Pongpeeradech, Nathakorn
collection PubMed
description GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. This study aimed to assess physicians’ diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results and how this affected the initiation of multidrug resistance (MDR) treatment. This study employed a mixed method: data were collected retrospectively from the medical records of TB patients and in-depth interviews were conducted with healthcare workers in areas with a high TB burden in Thailand. A total of 2,030 complete TB records from 2 patient groups were reviewed, including 1443 suspected cases with negative smear results and 587 with high risk of MDR-TB. GeneXpert MTB/RIF was routinely used to assist the physicians in their decision-making for the diagnosis of pulmonary tuberculosis (PTB) and the initiation of MDR-TB treatment. The physicians used it as a “rule-in test” for all patients with negative chest X-rays (CXR) and smear results, to ensure timely treatment. Approximately one-fourth of the patients with negative CXR/smear and GeneXpert MTB/RIF results were diagnosed with PTB by the physicians, who based their decisions on other evidence, such as clinical symptoms, and did not use GeneXpert MTB/RIF as a “rule-out test.” GeneXpert MTB/RIF proved effective in early detection within a day, thereby radically shortening the time required to initiate second-line drug treatment. Despite its high sensitivity for detecting PTB and MDR-TB, GeneXpert MTB/RIF had contradictory results (false positive and/or false negative) for 21.8% of cases among patients with negative smear results and 41.1% of cases among patients with high risk of MDR-TB. Therefore, physicians still used the results of other conventional tests in their decision-making process. It is recommended that GeneXpert MTB/RIF should be established at all points of care and be used as the initial test for PTB and MDR-TB diagnosis.
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spelling pubmed-93285362022-07-28 Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand Pongpeeradech, Nathakorn Kasetchareo, Yuthichai Chuchottaworn, Charoen Lawpoolsri, Saranath Silachamroon, Udomsak Kaewkungwal, Jaranit PLoS One Research Article GeneXpert MTB/RIF is a reliable molecular diagnostic tool capable of detecting Mycobacterium tuberculosis (MTB) and identifying genetic determinants of rifampicin (RIF) resistance. This study aimed to assess physicians’ diagnostic decision-making processes for TB based on GeneXpert MTB/RIF results and how this affected the initiation of multidrug resistance (MDR) treatment. This study employed a mixed method: data were collected retrospectively from the medical records of TB patients and in-depth interviews were conducted with healthcare workers in areas with a high TB burden in Thailand. A total of 2,030 complete TB records from 2 patient groups were reviewed, including 1443 suspected cases with negative smear results and 587 with high risk of MDR-TB. GeneXpert MTB/RIF was routinely used to assist the physicians in their decision-making for the diagnosis of pulmonary tuberculosis (PTB) and the initiation of MDR-TB treatment. The physicians used it as a “rule-in test” for all patients with negative chest X-rays (CXR) and smear results, to ensure timely treatment. Approximately one-fourth of the patients with negative CXR/smear and GeneXpert MTB/RIF results were diagnosed with PTB by the physicians, who based their decisions on other evidence, such as clinical symptoms, and did not use GeneXpert MTB/RIF as a “rule-out test.” GeneXpert MTB/RIF proved effective in early detection within a day, thereby radically shortening the time required to initiate second-line drug treatment. Despite its high sensitivity for detecting PTB and MDR-TB, GeneXpert MTB/RIF had contradictory results (false positive and/or false negative) for 21.8% of cases among patients with negative smear results and 41.1% of cases among patients with high risk of MDR-TB. Therefore, physicians still used the results of other conventional tests in their decision-making process. It is recommended that GeneXpert MTB/RIF should be established at all points of care and be used as the initial test for PTB and MDR-TB diagnosis. Public Library of Science 2022-07-27 /pmc/articles/PMC9328536/ /pubmed/35895742 http://dx.doi.org/10.1371/journal.pone.0271130 Text en © 2022 Pongpeeradech et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Pongpeeradech, Nathakorn
Kasetchareo, Yuthichai
Chuchottaworn, Charoen
Lawpoolsri, Saranath
Silachamroon, Udomsak
Kaewkungwal, Jaranit
Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title_full Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title_fullStr Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title_full_unstemmed Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title_short Evaluation of the use of GeneXpert MTB/RIF in a zone with high burden of tuberculosis in Thailand
title_sort evaluation of the use of genexpert mtb/rif in a zone with high burden of tuberculosis in thailand
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328536/
https://www.ncbi.nlm.nih.gov/pubmed/35895742
http://dx.doi.org/10.1371/journal.pone.0271130
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