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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2022
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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. |
format | Online Article Text |
id | pubmed-9328536 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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