Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2021.0100    [Accepted]
Published online November 2, 2021.
Head-to-head comparison of Xpert MTB/RIF with real-time polymerase chain reaction assay in bronchial washing specimens
Eunjeong Son, Jinook Jang, Taehwa Kim, Jin Ho Jang, Jae Heun Chung, Hee Yun Seol, Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Woo Hyun Cho, Yun Seong Kim, Doosoo Jeon
Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
Correspondence:  Doosoo Jeon,
Email: sooli10@hanmail.net
Received: 1 July 2021   • Revised: 5 September 2021   • Accepted: 2 November 2021
*Eunjeong Son and Jinook Jang contributed equally to this study as co-first authors.
Abstract
Backgrounds
With the introduction of the Xpert MTB/RIF assay (Xpert), its incorporation into the tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison to a commercial polymerase chain reaction (PCR) assay.
Methods
We retrospectively reviewed the medical records of patients having results of both the Xpert and the AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens.
Results
Of the 1,297 patients included in this study, 205(15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, the Xpert sensitivity in smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3 %; p =0.193). However, the Xpert sensitivity in smear-negative specimens was 70.6%, which was significantly higher compared to the AdvanSure assay (52.9 %; p=0.018). Using the phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than that of 3 days in the AdvanSure assay (p <0.001).
Conclusion
In comparison to the AdvanSure assay, the Xpert assay was more sensitive for smear-negative specimens, had a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in the Korean TB diagnostic algorithm.
Key Words: Tuberculosis, Polymerase Chain Reaction, Molecular Diagnostic Techniques
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